About the credentialing specialist role
A practice cannot bill a payer it isn't enrolled with, and claims dated before an effective date are usually lost for good. That makes credentialing the first job in the revenue cycle. As a credentialing specialist you take a provider from a stack of documents to active, in-network status with every payer the practice needs — and you keep them there.
Typical enrollment takes about five months from a complete file, and most of that is payer time. What makes the difference is the part we control: a clean, complete CAQH profile, every application submitted at once, and steady follow-up so nothing sits in a queue unnoticed.
What you will do
- Collect and verify provider documents: licences, DEA, board certification, malpractice, CV, W-9
- Build, audit and re-attest CAQH ProView profiles and grant payer access
- Prepare and submit commercial, Medicare and Medicaid applications and track each by payer
- Follow up with payers on a set schedule and log reference numbers, contacts and outcomes
- Confirm effective dates and loaded contracts before the first claim to each payer is sent
- Track expirables and run re-credentialing and revalidation ahead of deadlines
- Keep a clear status report for each provider that the practice can read at a glance
- Hand enrollment status to the billing team so claims are held or released correctly
What you need
- Two or more years of provider credentialing or payer enrollment experience
- Hands-on CAQH ProView, NPPES and payer portal experience
- Familiarity with Medicare enrollment (PECOS, CMS-855I/855B/855R) and state Medicaid enrollment
- Strong organisation — you will run dozens of applications at different stages
- Persistence and a professional manner on the phone with payer provider-relations teams
Helpful, not required
NAMSS credentials (CPCS or CPMSM), experience credentialing nurse practitioners or behavioral health clinicians (LCSW, LPC, LMFT, psychologists), and group contracting experience.
Working remotely at CredSpun
This is a fully remote, work-from-home role open to applicants living in the United States. You work during U.S. business hours alongside a named account team, inside each client practice's own EHR and practice management system, with every login tied to you personally. You need a quiet, private workspace, a reliable broadband connection and a computer that can run a current browser and a second monitor. HIPAA training is part of onboarding, and you sign our confidentiality terms before you are given access to any patient data.