Credentialing Specialist
Credentialing Specialist Job Description
The Credentialing Specialist will report to the VP of Strategy and Operations and work cross-functionally alongside other leaders like Director of Clinical Operations and Revenue Cycle Manager to ensure best in class care delivery for SimpliFed patients.This role is a key, hands-on contributor to a high-velocity remote credentialing team that is redefining how credentialing supports innovation in maternal health. This key role in the Operations team that will assist in maintaining active status for all providers and facilities by successfully completing initial and subsequent credentialing requests as required by the applicable state(s) and payers to service our SimpliFed patients.
Key Responsibilities
- Manage and maintain accurate provider credentialing files and profiles in CAQH, NPPES, PECOS, CMS, and payer portals.
- Coordinate full-cycle credentialing, re-credentialing, and insurance contracting with government and commercial payers.
- Maintain tracking logs for all Managed Care Organizations and payer applications, ensuring portal access remains active.
- Support new providers with credentialing setup, including NPI applications and CAQH profile completion.
- Process enrollment terminations for providers leaving the organization.
- Monitor expirations of licensure, DEA, board certification, and malpractice insurance, ensuring timely renewals.
- Communicate with payers to follow up on credentialing status and resolve delays or issues.
- Identify process gaps, recommend improvements, and escalate compliance or risk-related concerns as needed.
- Provide updated demographic and supporting documentation to external payers and billing entities as required.
- All other duties as assigned.
Qualifications
- Strong interpersonal and communication skills (verbal and written) while being empathetic and professional with internal/external partners.
- Proficient in Google Workspace.
- Experience in start-up environments with the ability to execute, adapt, and problem-solve.
- Innovative thinker who embraces experimentation and views setbacks as learning opportunities.
- Values collaboration, diversity, and continuous improvement.
- Passionate about SimpliFed’s mission and improving women’s health.
- Results driven and focused on streamlining processes and removes barriers to make the right thing easy.
- Strong organization skills to drive multiple, simultaneous credentialing efforts with a high-level of attention to detail.
About you
- Aligned with SimpliFed’s mission.
- Minimum of 2 years of direct provider credentialing and enrollment experience with PECOS, NPPES, CAQH, Managed Care Organizations, commercial plans, and clearinghouse portals (e.g., Availity, Candid).
- Experience tracking provider licensure, certification, and DEA/board expiration dates.
- A posture towards execution - a true operator willing to both develop the strategy and execute it.
- Ability to work remotely and communicate asynchronously via slack and email, along with thriving in virtual meetings.
- Does not suffer in silence: willingness to give it a shot but then reach out for help as needed and not waiting too long.
- Leans into items they are uncomfortable with, not avoid it.
- Defers to safe and secure security protocols always to protect SimpliFed’s patients and providers.
- High personal integrity to always do the right thing for the families that we are honored to serve.
- Respect and high tolerance for bureaucracy, along with an optimistic perspective on how to operate within the bureaucratic “rules” and the healthcare regulatory environment.
- Ability to work in a fast paced, team environment.
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