Credentialing Specialist (Healthcare Services) - A253

Industry

Healthcare / Telemedicine

Work Arrangement

Fully Remote

Job Type

Full-time

Work Schedule

Monday–Friday, 40 hours/week, US time zone overlap required

Locations

Philippines, LATAM, South Africa, Anywhere Remote

About Pearl Talent

Pearl works with the top 1% of candidates from around the world and connects them with the best startups in the US and EU. Our clients have raised over $5B in aggregate and are backed by companies like OpenAI, a16z, and Founders Fund. They’re looking for the sharpest, hungriest candidates who they can consistently promote and work with over many years. Candidates we’ve hired have been flown out to the US and EU to work with their clients, and even promoted to roles that match folks onshore in the US.

Hear why we exist, what we believe in, and who we’re building for: WATCH HERE

Why Work with Us?
At Pearl, we’re not just another recruiting firm—we connect you with exceptional opportunities to work alongside visionary US and EU founders. Our focus is on placing you in roles where you can grow, be challenged, and build long-term, meaningful careers.

About the Company

Our client is a rapidly scaling healthcare services company expanding access to care for families across multiple U.S. states.

Role Overview

The Credentialing Specialist manages provider enrollment and payer credentialing across Medicaid, Medicaid Managed Care Organizations (MCOs), and commercial insurance plans. You will own new contracts and credentialing end-to-end, 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. Candidates who thrive in structured, high-volume, and fast-paced environments will excel here.

Your Impact:

• Ensure providers are credentialed and enrolled efficiently, enabling timely patient care delivery.
• Reduce delays and errors in provider onboarding through accurate documentation and proactive follow-ups.
• Support payer contract expansions and state-specific credentialing compliance, directly impacting company growth.
• Improve operational efficiency and provider satisfaction by streamlining credentialing workflows.

Core Responsibilities

Provider Credentialing & Enrollment – 45%

• 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 – 30%

• 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 – 15%

• 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 – 10%

• 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.

Must-Haves (Required)

• 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 (Preferred)

• 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.

Tools Proficiency

Must-Haves (Required)
CAQH ProView, State Medicaid Portals, Email, Slack, Spreadsheets, Internal Credentialing Systems

Nice-to-Haves (Preferred)
Practice Management or Billing Systems, Workflow or Project Management Tools

• Competitive Salary: Based on experience and skills

• Remote Work: Fully remote—work from anywhere
• Performance Bonus: Based on data accuracy, reporting timeliness, and overall sales efficiency
• Team Incentives: Recognition for maintaining 100% 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

1. Application
2. Screening
3. Skills Assessment
4. Top-grading Interview
5. Client Interview
6. Job Offer
7. 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.