About the position
The Credentialing Specialist plays a critical role in ensuring the accuracy, efficiency, and compliance of provider credentialing processes within a growing digital health environment. This position is responsible for managing provider credentialing, enrollment, and re-credentialing with health plans, regulatory bodies, and partner organizations. The ideal candidate has a strong understanding of credentialing best practices, compliance requirements, and digital tools to streamline workflows.
Responsibilities
• Own end-to-end provider credentialing from intake through committee-ready files, completing PSV and ensuring compliance with NCQA standards and internal policy.
• Maintain data integrity across systems by proactively reconciling discrepancies and tracking licenses, certifications, training, and expirables to keep records audit-ready.
• Continuously improve throughput and quality by leveraging digital tools and automation and staying current on NCQA, CMS, CAQH, and payer policy changes.
• Collaborate across payer enrollment and partner operations teams to streamline handoffs, solve problems quickly, and build repeatable processes that improve enrollment speed and quality.
• Support partner and provider communication by helping unblock complex escalations, drafting crisp updates, and coordinating internal and external stakeholders as needed.
• Conduct QA on credentialing files against internal rubrics and NCQA standards before committee submission, identifying and resolving discrepancies, time gaps, and red flags.
Requirements
• 2–5+ years of credentialing experience in a high-volume, fast-paced environment (digital health, MSO, or healthcare operations).
• Exceptional written and verbal communication skills and comfortable (and confident) coordinating across internal and external stakeholders, translating complex credentialing issues into clear updates, next steps, and expectations.
• Detail-oriented with strong organizational skills and able to manage a large queue of enrollments across multiple payers and partners without dropping balls.
• Proficiency in startup tech stack (Google Workspace, Notion, Slack, etc…).
Nice-to-haves
• Experience with Salesforce or similar CRM/credentialing platforms (Verifiable, Medallion, or similar) preferred.
• Experience with digital process optimization is a plus, along with a strong understanding of NCQA, CAQH, and/or experience using credentialing software such as Verifiable, Medallion, Andros, CertifyOS, or similar.
Benefits
• Be a foundational member of a company revolutionizing how clinics interact with insurance; partnering directly with clinic leaders.
• Direct impact on patient access, clinic sustainability, and affordability of care.
• Strong support from leadership and investors; a culture that values experimentation, clarity, and doing the hard stuff right.