Credentialing Specialist

4 weeks ago

Cebu City, Central Visayas, Philippines Pearl Full time

Work Arrangement:Fully Remote

Job Type:Full-Time

Work Schedule: 9:00 AM - 5:00 PM PST

Holiday Orientation:US Holidays

About Pearl Talent

Pearl works with the top 1% of candidates from around the world and connects them with the best startups in the US and EU. Our clients have raised over $5B in aggregate and are backed by companies like OpenAI, a16z, and Founders Fund. They're looking for the sharpest, hungriest candidates who they can consistently promote and work with over many years. Candidates we've hired have been flown out to the US and EU to work with their clients, and even promoted to roles that match folks onshore in the US.

Hear why we exist, what we believe in, and who we're building for:Watch here

Why Work with Us?

We're not just another recruiting firm—we focus on placing candidates with exceptional US and EU founders who prioritize the long-term success of their team members. We also provide retention bonuses at 3, 6, 9, and 12 months, as well as community-driven benefits like an annual retreat.

About the Company

The Company is a healthcare technology platform designed to simplify patient record management by using AI to generate real-time, customized summaries of medical data. It integrates seamlessly with electronic health record (EHR) systems, allowing healthcare providers to quickly access vital patient information. Hona's key offerings include the ability to retrieve patient records in as little as 15 minutes, generate tailored reports, and ensure HIPAA compliance with secure data storage.

The tool is particularly useful for hospitals, specialty care providers, and telehealth services aiming to streamline workflows and improve patient care. It also allows providers to conduct live, real-time simulations of patient data access during appointments

Role Overview

We are seeking a highly experienced Credentialing Specialist to join our growing healthcare team, with a strong focus on Applied Behavioral Analysis (ABA) Therapy. The ideal candidate is a self-starter who can drive credentialing processes from end to end and has a proven track record of working with both Medicaid and commercial payer enrollments. This role demands deep familiarity with payer portals, including Availity, NPI registration, and related credentialing platforms.

Key Responsibilities
  • Own and manage the entire credentialing and recredentialing process, ensuring provider files are accurate, complete, and in compliance with regulatory standards.
  • Facilitate Medicaid enrollments and commercial insurance enrollments, including managing parent and group enrollments.
  • Maintain up-to-date provider information in credentialing software and payer databases.
  • Use payer portals such as Availity, CAQH, and NPPES to submit and track enrollment applications.
  • Ensure compliance with standards set by NCQA, URAC, CMS, and state Medicaid agencies.
  • Collaborate with internal departments to ensure timely and efficient onboarding of providers.
  • Monitor and proactively manage expiring credentials, licenses, certifications, and contracts.
  • Act as the subject matter expert in credentialing for ABA therapy providers and services.
  • Prepare credentialing files for audits, committee review, and payer submission.
  • Resolve enrollment issues with payers and follow up on outstanding applications

Must-Haves:
  • Experience:
    • 3 - 5+ years of healthcare credentialing experience required.
    • Extensive experience with ABA Therapy credentialing is highly preferred.
    • Hands-on experience with Medicaid, commercial payers, and payer portals including Availity and NPI/NPPES.
  • Strong organizational, communication, and analytical skills.
  • Ability to manage multiple priorities and deadlines with minimal supervision.
  • Proficiency in credentialing systems (e.g., CACTUS, Echo, or Verity) and Microsoft Office Suite.
Nice-To-Haves:
  • Familiarity with payer-specific requirements for ABA therapy credentialing and billing.
  • Experience navigating Medicaid enrollment processes across multiple states.
  • Understanding of insurance group enrollments and maintenance of payer rosters.
  • Ability to communicate effectively with insurance representatives and healthcare providers.

Compensation Package:

  • Remote Work: Fully remote—work from anywhere
  • Generous PTO: Ample paid time off to rest and recharge
  • Direct Mentorship: Grow through guidance from international industry experts
  • Learning & Development: Ongoing access to resources for professional growth
  • Global Networking: Work and connect with professionals around the world
  • Work-Life Balance: Flexible hours that support a healthy work-life balance

Our Recruitment Process:

  1. Application
  2. Screening
  3. 30 minute Interview
  4. Skills Assessment
  5. Client Interview
  6. Job Offer
  7. Client Onboarding
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