Role Description

The Credentialing Specialist is responsible for managing insurance credentialing, payer enrollments, and regulatory compliance related to healthcare plans and government programs such as Medicare. This person will ensure that all provider and organizational credentialing requirements are completed accurately, submitted on time, and kept up to date. They will also support audits and maintain documentation to ensure the company remains fully compliant with payer requirements. This role is critical to enabling BetterHealth to maintain existing payer relationships and expand into new insurance networks.

Key Responsibilities

• Credentialing & Payer Enrollment
  • Manage the credentialing and recredentialing process for healthcare plans, including Medicare and commercial payers.
  • Prepare, complete, and submit payer enrollment applications and supporting documentation.
  • Monitor application status and follow up with payers to ensure approvals and timely processing.
  • Maintain accurate records of credentialing approvals, renewals, and expirations.
• Contract & Compliance Management
  • Track contract renewal dates and credentialing deadlines to ensure no lapses in network participation.
  • Maintain internal documentation and compliance records for payer agreements and credentialing files.
  • Ensure the organization remains compliant with payer requirements and regulatory guidelines.
• Audit Coordination
  • Support preparation for Medicare and payer audits.
  • Organize documentation and coordinate logistics for audits, including scheduling and documentation readiness.
  • Ensure all credentialing records and compliance materials are properly maintained and accessible.
• Operational Support
  • Maintain credentialing databases and documentation systems.
  • Collaborate with internal operations teams to ensure payer requirements are met.
  • Identify opportunities to streamline credentialing and enrollment processes.

Qualifications

• 2+ years of experience in healthcare credentialing, payer enrollment, or medical billing operations.
• Experience working with U.S. healthcare insurance systems, including Medicare and commercial plans.
• Familiarity with credentialing documentation, payer applications, and compliance requirements.
• Strong organizational and documentation management skills.
• Ability to manage multiple applications, deadlines, and payer requirements simultaneously.
• Excellent written and verbal communication skills.
• High attention to detail and accuracy.

Nice to Have

• Experience supporting Medicare audits or regulatory compliance reviews.
• Experience working with credentialing software or healthcare CRM systems.
• Experience working remotely with U.S.-based healthcare organizations.

What Success Looks Like

• All credentialing and payer enrollments are submitted accurately and on time.
• No lapses in insurance contracts or credentialing approvals.
• Payer audits and compliance checks run smoothly with organized documentation.
• The organization can quickly and confidently expand into new payer networks.