Licensing and Credentialing Specialist

Job Summary

To ensure timely provider enrollment and compliance, the full-time remote Licensing and Credentialing Specialist will manage end-to-end payer enrollment activities, support provider licensing operations, and maintain accurate provider data across various platforms.

Key Responsibilities

• Own the end-to-end payer enrollment process for new and existing providers across commercial, Medicare, and Medicaid health plans
• Serve as the primary contact with health plans and internal stakeholders to resolve enrollment issues and ensure timely provider participation
• Conduct routine audits of provider enrollment and credentialing files to ensure compliance with NCQA, CMS, and payer-specific requirements

Required Qualifications

• Bachelor's Degree in Healthcare Administration or a related field
• 3+ years of experience in provider payer enrollment and credentialing
• Experience managing provider enrollments with commercial, Medicare, and Medicaid payers
• Working knowledge of CAQH, payer portals, and provider credentialing systems
• Understanding of NCQA, CMS, state licensing, and payer credentialing requirements