Contracting and Credentialing Specialist (Ashley)

Overview

This role supports virtual healthcare clinician credentialing and government contracting operations by owning the end-to-end enrollment and registration lifecycle for providers and entities. Work is highly deadline-driven and includes Medicare/Medicaid enrollments, payer applications, state licensure support, and federal/state contracting registrations.

Responsibilities

Medicare (CMS / PECOS / I&A)

• Maintain CMS Identity & Access (I&A) accounts, surrogate relationships, and PECOS access for providers and organizations
• Prepare, submit, and track CMS-855B, 855I, 855R, 855O, CMS-588 (EFT), and EDI enrollment applications
• Manage reassignments of benefits, group enrollments, practice location changes, and ownership/managing-control disclosures
• Own the revalidation calendar and ensure no missed deadlines
• Correspond with MACs on development requests, name-matching issues, and application deficiencies; escalate and follow through to approval

Medicaid

• Complete and track state Medicaid enrollments and re-enrollments across multiple states
• Maintain CAQH ProView profiles, NPPES/NPI records, and payer portal access
• Track application status, effective dates, and par/non-par status in the credentialing tracker; report status weekly

Government Contracting

• Maintain SAM.gov registration, UEI, CAGE code, and annual renewals
• Support VA community care network enrollment (TriWest/Optum), state contracts, and other public-sector opportunities
• Prepare and update capability statements, representations and certifications, and required entity documentation
• Monitor solicitations, flag relevant opportunities, and assemble supporting documents for bids and RFPs

Documentation & Process

• Keep entity documentation organized and current (EINs, IRS Letter 147C, W-9s, state registrations, registered agent records, MSO/PC structure documents used in payer applications)
• Maintain and improve credentialing SOPs and trackers
• Provide a concise weekly status report including what moved, what is blocked, and what is at risk

Required Qualifications

• 3+ years of hands-on provider enrollment and credentialing experience
• Direct, independent experience with CMS I&A and PECOS
• Multi-state Medicaid and commercial payer enrollment experience
• Working knowledge of CAQH, NPPES, and payer credentialing portals
• Strong written communication skills (including drafting payer and agency correspondence)
• Meticulous documentation habits and comfort managing dozens of parallel deadlines
• U.S.-based with a Social Security Number (required to establish individual CMS I&A credentials)
• Reliable high-speed internet and a private, HIPAA-appropriate work environment

Preferred Qualifications

• CPCS or CPMSM certification
• Telehealth or multi-state virtual care experience
• Experience with group practice enrollments under an MSO or management services structure
• Prior SAM.gov / federal contracting registration experience
• Experience with VA community care networks (TriWest, Optum)
• Familiarity with therapy disciplines (PT/OT/SLP) and behavioral health credentialing requirements

Compensation & Benefits

• Part-time, hourly W2 role
• Hours will not exceed 29 hours per week

Location

• Fully remote
• Availability is required for payer and MAC phone calls during business hours
• Company laptop provided for all work

Schedule & Work Arrangement

• Flexible schedule within standard U.S. business hours
• Accurate time tracking is required; all hours must be recorded and approved

Hiring Process

• Application review & 10-minute screening interview
• 30-minute live interview
• Reference check and background check

Additional Information

• Employment is contingent on successful completion of a background check and exclusion screening (OIG, SAM, OFAC)
• This position is employment at will. Nothing in this posting constitutes a contract or guarantee of employment or any minimum number of hours.