Credentialing Specialist

Overview Role: Credentialing Specialist – manage provider enrollment and payer credentialing across Medicaid, Medicaid MCOs, and commercial insurance plans. Own end-to-end credentialing, ensuring clinicians are in-network quickly and accurately. This role requires strong attention to detail, process-driven execution, and comfort navigating complex multi-state payer systems. Work Arrangement: Fully Remote Location options: Philippines, LATAM, South Africa, Anywhere Remote About Pearl Talent Pearl Talent connects top candidates with startups in the US and EU. We focus on placing candidates where they can grow and build long-term careers. Responsibilities Manage end-to-end credentialing and re-credentialing for providers with Medicaid, Medicaid MCOs, and commercial payers. Prepare, submit, and track credentialing applications for individual and group NPIs. Maintain accurate provider records, documentation, and enrollment statuses across multiple states. Identify missing or incomplete documentation and resolve gaps with providers. Your Impact Ensure providers are credentialed and enrolled efficiently to enable timely patient care. Reduce delays and errors in provider onboarding through accurate documentation and proactive follow-ups. Support payer contract expansions and state-specific credentialing compliance, impacting company growth. Improve operational efficiency and provider satisfaction by streamlining credentialing workflows. Core Responsibilities Manage end-to-end credentialing and re-credentialing for providers with Medicaid, Medicaid MCOs, and commercial payers. Prepare, submit, and track credentialing applications for individual and group NPIs. Maintain accurate provider records, documentation, and enrollment statuses across multiple states. Identify missing or incomplete documentation early and proactively resolve gaps with providers. Payer Contracting & State Expansion Lead new payer contract submissions and geographic expansions, prioritizing key states. Coordinate enrollments with regional and national commercial insurance plans. Work directly with state Medicaid agencies, MCOs, and commercial payers to resolve issues. Monitor payer timelines and escalate delays or systemic issues when necessary. Compliance, Tracking & Audits Monitor revalidations, re-credentialing cycles, and ongoing compliance requirements. Support payer audits and respond to credentialing inquiries. Stay current on state-specific Medicaid rules and commercial payer policies. Ensure credentialing data accuracy across internal systems. Cross-Functional Coordination Partner with operations, onboarding, and billing teams to support timely provider go-lives. Communicate status updates, risks, and blockers clearly to internal stakeholders. Document credentialing processes and best practices to support organizational scaling. Requirements 2+ years of experience in healthcare credentialing, enrollment, or payer contracting. Hands-on experience with Medicaid, Medicaid MCOs, and commercial insurance credentialing. Experience managing credentialing across multiple U.S. states. Strong familiarity with CAQH, state Medicaid portals, and commercial payer systems. Exceptional attention to detail and ability to manage high-volume workflows. Strong written and verbal English communication skills. Ability to work independently and own processes end-to-end. Nice-to-Haves Experience supporting behavioral health, ABA, or allied health providers. Prior credentialing experience in NC, GA, AZ, VA, or HI. Background in startup or high-growth healthcare environments. Must-Haves & Tools CAQH ProView, State Medicaid Portals, Email, Slack, Spreadsheets, Internal Credentialing Systems Practice Management or Billing Systems, Workflow or Project Management Tools Benefits Competitive Salary: Based on experience and skills Remote Work: Fully remote—work from anywhere Performance Bonus: Based on data accuracy, reporting timeliness, and overall efficiency Team Incentives: Recognition for CRM hygiene and on-time reporting Generous PTO: In accordance with company policy Health Coverage for PH-based talents: HMO coverage after 3 months for full-time employees Direct Mentorship: Guidance from international industry experts Learning & Development: Ongoing access to resources for professional growth Global Networking: Connect with professionals worldwide Our Recruitment Process Application Screening Skills Assessment Top-grading Interview Client Interview Job Offer Client Onboarding Ready to Join Us? If this role aligns with your skills and goals, apply now to take the next step in your journey with Pearl Talent. #J-18808-Ljbffr