Credentialing Specialist
Clarity RCM
- New York, New York, United States
- New York, New York, United States
Über
Own the full lifecycle of credentialing for physicians and advanced practice providers, including initial onboarding, primary source verification, re-credentialing, and ongoing monitoring. Verify education, training, licenses, board certifications, malpractice insurance, and work history with complete accuracy. Ensure all credentialing files meet NCQA, TJC, CMS, and payer-specific requirements. Payer Enrollment and Maintenance
Prepare, submit, and track enrollment applications with commercial payers including BCBS, UHC, Aetna, and Cigna, as well as Medicare and Medicaid. Manage CAQH ProView including quarterly attestations and document maintenance. Process Medicare enrollments and updates through PECOS. Verify that providers are correctly linked to group tax IDs to prevent out-of-network billing issues. Track effective dates and panel statuses and communicate updates to internal stakeholders. Process Building and Workflow Design
Create structure in areas that currently have few or inconsistent processes. Organize credentialing inputs from multiple sources and turn them into clear workflows, trackers, and checklists. Identify bottlenecks, design solutions, and implement improvements that enhance accuracy, speed, and consistency. Document processes and maintain updated SOPs that support ongoing team alignment and scale. Cross-Functional Collaboration
Work closely with internal teams to keep credentialing and enrollment workflows moving. Support account managers, operations, and revenue cycle teams by providing accurate status updates and resolving credentialing-related blockers. Partner with billing and AR teams to investigate and resolve claim denials caused by credentialing or enrollment issues. Data Management and Documentation
Maintain accurate provider data across CAQH, PECOS, payer portals, and internal systems. Own a master tracker that includes effective dates, expirables, re-credentialing deadlines, panel statuses, and outstanding items. Keep all credentialing records continuously audit-ready with complete and up-to-date documentation. Licensing Support
Monitor expiring state licenses, DEA registrations, malpractice insurance, and board certifications. Communicate proactively with providers to ensure renewals are completed well before expiration dates. What You Will Bring
Experience: 2 to 3 years of hands-on medical credentialing or payer enrollment experience. Technical Knowledge: Familiarity with CAQH, PECOS, payer portals, and credentialing software. Strong understanding of NCQA, TJC, CMS, and standard credentialing requirements. Structure Building: A track record of bringing order to complex or unstructured environments and building processes that scale. Attention to Detail: Ability to identify inconsistencies instantly and maintain clean, accurate files. Follow-Through: Persistent and professional when gathering documentation or resolving gaps. Communication: Clear, concise, and confident written and verbal communication skills. Technology Mindset: Comfortable navigating multiple systems and adopting new tools. Judgment: Ability to handle PHI and sensitive information with complete discretion. Mindset: Process-driven, organized, proactive, resourceful, and committed to continuous improvement.
Additional Details Location: Fully remote role based in the United States. Compensation: Competitive salary with benefits, commensurate with experience. Why Join Clarity RCM At Clarity, you will join a mission-driven, founder-led organization transforming how independent dermatology practices operate. You will help build a credentialing function known for accuracy, speed, and reliability, and you will be part of a culture that values operational excellence, collaboration, and continuous improvement.
Sprachkenntnisse
- English
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