Credentialing Specailist

As a Credentialing Specialist at Metro Vein Centers, you are an integral team member to our continued growth. This role is responsible for provider credentialing, provider licensing, recredentialing, and onboarding support to ensure providers maintain the credentials and licenses needed for timely start dates and uninterrupted patient care. The role also supports Medicare/Medicaid and commercial payer enrollment activities as needed. Reporting to the Supervisor of Credentialing, you’ll work daily with CAQH, state licensing boards, payer portals (e.g., Availity), Medicare PECOS, and our credentialing database, collaborating closely with Recruitment, Clinical leadership, and RCM. The ideal candidate is detail-oriented, process-driven, and has hands-on experience in both provider credentialing and provider licensing.

This is a remote role; we’re looking for a self-starter with strong ownership and follow-through.

What You’ll Do

• Manage provider credentialing and recredentialing activities, including collecting and verifying documentation, maintaining complete records, and tracking application progress.
• Process and track initial provider license applications, renewals, and license maintenance across applicable state licensing boards.
• Maintain CAQH attestations and accurate provider data across payer portals and internal credentialing systems.
• Monitor credentialing and licensing expirables, revalidations, and recredentialing deadlines to prevent lapses or delays.
• Support onboarding new providers: gather documents, set up NPI/taxonomy/locations, verify credentials and licenses, and coordinate start-date readiness.
• Coordinate with providers and state licensing boards to obtain documentation, monitor application status, and resolve outstanding licensing requirements.
• Track provider license expiration dates, application statuses, and outstanding requirements to prevent onboarding delays or interruptions in practice.
• Support Medicare/Medicaid (PECOS) and commercial payer enrollment submissions, follow-ups, and effective-date tracking as assigned.
• Respond to credentialing, licensing, and payer requests; supply additional documentation and resolve application issues promptly.
• Escalate concerns and complex cases to the Supervisor of Credentialing for timely resolution and participate in special projects as needed.

What You’ll Bring

• 2+ years of experience in provider credentialing (physician group, MSO, health plan, or hospital).
• Required hands-on provider licensing experience, including initial applications, renewals, license verification, and tracking.
• Working knowledge of state medical or professional licensing board requirements, application processes, and license maintenance.
• Hands-on with CAQH (attestations/rosters) and credentialing systems; familiarity with Medicare PECOS and payer portals (e.g., Availity).
• Working knowledge of provider onboarding, credentialing and recredentialing requirements; familiarity with Medicare/Medicaid and commercial payer enrollment processes.
• Proficient in credentialing systems (e.g., MD-Staff/Cactus) and Excel/Google Sheets.
• Strong data accuracy and documentation habits; able to maintain clean provider records across multiple systems.
• Effective written/verbal communication with payers, providers, and internal stakeholders; escalates issues appropriately.
• Proven ability to prioritize in a high-volume environment, meet deadlines, and follow SOPs with minimal supervision.
• Self-starter mindset with ownership and follow-through in a remote setting.
• High school diploma or equivalent required

Benefits to Support Your Wellbeing & Lifestyle

Full-time team members at Metro Vein Centers are eligible for:

• Medical, Dental, and Vision Insurance
• 401(k) 
• Paid Time Off (PTO) + Paid Company Holidays
• Company-Paid Life Insurance
• Short-Term Disability Insurance
• Employee Assistance Program (EAP)
• Career Growth & Development Opportunities