Credentialing Specialist

Remote
Full Time
Experienced
Credentialing Specialist
Remote | Full‑Time | Non‑Exempt (Hourly)

Position Summary
The Credentialing Specialist is responsible for end‑to‑end credentialing and re‑credentialing of mental health clinicians, with a focus on complex payer enrollment, system ownership, and process oversight. This role serves as the subject‑matter expert for credentialing workflows and Modio, ensuring accuracy, efficiency, and regulatory compliance across all provider enrollments.
This is a hands‑on, non‑managerial role that partners closely with Operations and Clinical Leadership while independently managing higher‑level credentialing responsibilities.

Essential Job Duties
Credentialing & Enrollment
  • Manage the full lifecycle of credentialing and re‑credentialing for all new and current clinicians across commercial and Medicaid payers.
  • Request, review, verify, and submit all required provider documentation, including:
    • Licensure
    • Malpractice insurance
    • CAQH profiles
    • DEA and other certifications
  • Initiate and monitor payer applications for both individual and group contracts.
  • Ensure clinicians are added correctly to existing payer contracts and panels.
  • Track all credentialing activity from submission through approval, proactively following up with payers to ensure timely completion.
  • Identify delays, missing information, or payer issues and escalate when appropriate.

System Ownership & Process Oversight
  • Own and maintain Modio as the system of record for credentialing workflows, application statuses, and credential expirations.
  • Ensure credentialing data is accurate, complete, and consistently updated.
  • Identify workflow inefficiencies and recommend or implement process improvements to reduce turnaround time.
  • Maintain organized tracking of:
    • Payer submissions
    • Approval timelines
    • Re‑credentialing cycles
    • License, insurance, and certification expirations

Communication & Cross‑Functional Support
  • Serve as a key point of contact for credentialing questions from clinicians.
  • Support onboarding team to ensure turnaround time for new clinicians.
  • Communicate upcoming expirations or risk items to Operations and Clinical Leadership.
  • Participate in meetings related to credentialing operations and workflow optimization.
  • Provide support and guidance to other administrative staff as a credentialing subject‑matter resource (without formal people management).

Compliance & Professional Standards
  • Adhere to HIPAA, payer requirements, and all applicable regulatory standards.
  • Maintain the highest standards of confidentiality and professionalism.
  • Support a trauma‑informed, respectful, and collaborative work culture.
  • Comply with all company policies, procedures, and legal requirements.

Qualifications
Required
  • Minimum 3 years of credentialing experience, preferably in:
    • Mental health
    • Behavioral health
    • Multi‑provider or telehealth organizations
  • Demonstrated experience managing:
    • CAQH
    • Re‑credentialing cycles
    • Commercial and Medicaid payers
    • Familiarity with PECOS
  • Comfort independently managing systems and workflows
  • Strong attention to detail and organizational skills
  • Excellent written and verbal communication skills
Preferred
  • Experience supporting multi‑state provider enrollment
  • Familiarity with NPPES, Availity, Optum, and payer portals
  • Bachelor’s degree (preferred, not required)
  • Bilingual (Spanish a plus)
Physical Requirements
  • Prolonged periods of sitting and working at a computer
Compensation Range
$26.00 – $30.00 per hour, DOE
 
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