Medical Licensing & Credentialing Specialist

This is a remote position.

Job Description

Oversee and manage all provider licensing and credentialing aspects, ensuring compliance with regulatory and payor requirements

Coordinate multi-state license applications, renewals and verifications

Support provider enrollment process with major payors, including Medicare, Medicaid, Medicaid Managed Care Organizations and private insurance companies

Maintain accurate and up to date documentation using the Medallion platform, ensuring timely renewals and meeting compliance deadlines

Manage payor logins and facilitate access for providers and the billing team to ensure smooth claims processing and efficient operations

Collaborate with internal teams to support provider onboarding, transitions and exit processes

Develop and maintain clear policies and procedures for licensing and credentialing requirements

Identify opportunities to improve processes, streamline operations and enhance efficiency

Provide training and resources to providers and staff regarding licensing, credentialing and compliance standards

Generate reports and provide updates to leadership on credentialing and licenses activities

Assist with audits, inspections and any compliance-related inquiries

Performs other duties as assigned

Experience

Minimum of 2 years experience in medical licensing, credentialing or related field

Preferred experience managing multi-state licensing and credentialing processes

Familiarity with major payors, including Medicare and Medicaid, Medicare Advantage Plans and private insurance companies

Strong organizational and communication skills, with attention to detail

Be able to multitask in fast paced environment