Credentialing Specialist

This is a remote position.

Virtual Rockstar is hiring a Credentialing Specialist on behalf of our client — a multi-location pediatric therapy practice based in Minnesota. This growing organization provides life-changing occupational, physical, and speech therapy services to children and families, and they're seeking a detail-oriented professional to ensure providers are credentialed accurately and efficiently across multiple insurance payers.

This is an exciting opportunity to join a collaborative and mission-driven team dedicated to helping children reach their fullest potential.

As the Credentialing Specialist, you'll manage the credentialing and re-credentialing process for providers across multiple locations and payers. You'll be responsible for maintaining accurate records, ensuring deadlines are met, and communicating proactively with insurance companies to track the progress of applications.

You'll also work closely with the HR department on additional HR administrative tasks and the billing department to follow up on unpaid claims, assist with denials, and support appeals processes — helping maintain a seamless revenue cycle.

About Our Client
Our client operates a network of pediatric therapy clinics offering a range of services that support children's developmental growth. Their culture is collaborative, compassionate, and family-focused — and they pride themselves on fostering strong relationships with their providers, patients, and community partners.

They're looking for a skilled Credentialing Specialist who can streamline provider enrollments, manage payer communications, and support the billing team in ensuring clean, timely claim submissions and appeals.

Responsibilities
Provider Credentialing

• Create and manage new provider profiles in CAQH and maintain updates for existing providers
• Obtain NPI numbers and manage all related documentation
• Complete Medicare and Medicaid (MA) enrollments via PECOS Online Portal
• Establish and maintain payer connections for new and existing therapists
• Monitor the credentialing tracker daily, following up with insurance payers as needed via email or phone
• Save all confirmation documents in provider folders and update credentialing statuses in internal systems (e.g., Linus)
• Process offboarding for departing therapists by notifying payers and closing active enrollments

Insurance Communication & Denial Follow-up

• Contact insurance companies when credentialing applications are denied or delayed to identify and resolve issues
• Maintain professional and timely communication with payer representatives
• Document all correspondence and updates for internal records

Billing Support

• Collaborate with the billing department to follow up on unpaid or denied claims
• Assist with appeals and claim resubmissions as directed by the billing lead
• Track and report on outstanding claims and trends in payer responses

HR Administrative Support

• Organize and maintain digital credentialing and HR files
• Support reporting and compliance documentation for internal and external audits
• Assist with HR tasks as needed

Requirements
Experience & Knowledge

• 2+ years of experience in provider credentialing, payer enrollment, or medical billing support (preferably in a therapy or multi-site healthcare setting)
• Strong understanding of CAQH, NPI, Medicare, and Medicaid (MA) enrollment processes
• Familiarity with insurance payers, credentialing workflows, and medical billing systems
• Experience in following up with insurance companies and managing appeals

Technical Skills

• Proficient with Microsoft Office 365 (Word, Excel, Outlook, Teams)
• Comfortable using ticketing or workflow systems for communication and task management
• Strong data entry and documentation skills with high attention to detail

Soft Skills

• Excellent communication and follow-up abilities (email and phone)
• Highly organized and deadline-driven
• Ability to work independently while collaborating with billing and HR teams
• Professional, dependable, and proactive in problem-solving

Benefits

• Competitive salary commensurate with experience.
• Opportunities for professional development and growth.
• Work in a dynamic and supportive team environment.
• Make a meaningful impact by helping to build and strengthen families across the globe.