Contracting & Credentialing Specialist
Location
United States
Posted
15 days ago
Salary
Not specified
No structured requirement data.
Job Description
Role Description
We're hiring a Contracting & Credentialing Specialist who will be responsible for supporting all credentialing, licensing, and payer contracting activities within the Managed Care Contracting & Credentialing Department. This role ensures MD, APRN, RPSGT, RTT profiles and facilities are appropriately credentialed and licensed (include Rx authority and autonomous practice when applicable), re-credentialed, and contracted in compliance with regulatory, payer, and organizational requirements.
- Coordinate end-to-end provider credentialing and re-credentialing processes with commercial and government payers, including application submission
- Prepare, submit, and track credentialing applications through CAQH and payer portals
- Support payer contracting activities, including data collection, application submission, and follow-up
- Submit and follow up on licensing activities with multi-state boards and provide update and visibility to leadership
- Maintain accurate provider credentialing files in accordance with regulatory and accreditation standards (federal, state and local regulations)
- Monitor credentialing timelines and proactively address delays or deficiencies
- Serve as a liaison between providers, internal departments, and payers regarding credentialing, licensing and contracting status
- Maintain credentialing databases and ensure data integrity across systems
- Assist with audits, reporting, and credentialing (licensing) metrics as requested
- Support licensing needs guided by the organizations growth
- Stay current on payer requirements, regulatory changes, and industry best practices
- Provide administrative and project support to the Senior Manager of Contracting & Credentialing as needed
Qualifications
- Bachelor’s degree or equivalent experience preferred
- 3+ years of experience in provider credentialing, licensing and/or managed care contracting
- Sleep Clinic, Sleep device and Telehealth (multi-state) experience is a plus
- Strong working knowledge of state boards, CAQH, payer portals, and credentialing workflows
- Familiarity with ACHC, AASM, CMS, and state regulatory requirements
- Strong attention to detail, organization, and follow-up skills
- Ability to manage multiple priorities and deadlines in a fast-paced environment
- Excellent written and verbal communication skills
- Credentialing certification (CPCS or CPMSM) a plus
Benefits
- Meaningful work that directly improves peoples’ lives
- Be part of an international team across the US, France, Belgium
- Annual team offsite
- Comprehensive health benefits (medical, dental, vision)
- FREE One Medical membership
- 401(k) with company match
- 20 days PTO + 10 paid holidays + 80 hours paid sick leave
- Monthly phone and internet stipend
Compensation
$60,000 - $70,000 depending on experience.
Our Core Values
At Sunrise Group, we keep things clear and simple ✨, value trust and collaboration 🤝, and lead with optimism and compassion 🌞. These values guide everything we do.
Job Requirements
- Bachelor’s degree or equivalent experience preferred
- 3+ years of experience in provider credentialing, licensing and/or managed care contracting
- Sleep Clinic, Sleep device and Telehealth (multi-state) experience is a plus
- Strong working knowledge of state boards, CAQH, payer portals, and credentialing workflows
- Familiarity with ACHC, AASM, CMS, and state regulatory requirements
- Strong attention to detail, organization, and follow-up skills
- Ability to manage multiple priorities and deadlines in a fast-paced environment
- Excellent written and verbal communication skills
- Credentialing certification (CPCS or CPMSM) a plus
Benefits
- Meaningful work that directly improves peoples’ lives
- Be part of an international team across the US, France, Belgium
- Annual team offsite
- Comprehensive health benefits (medical, dental, vision)
- FREE One Medical membership
- 401(k) with company match
- 20 days PTO + 10 paid holidays + 80 hours paid sick leave
- Monthly phone and internet stipend
- Compensation
- $60,000 - $70,000 depending on experience.
- Our Core Values
- At Sunrise Group, we keep things clear and simple ✨, value trust and collaboration 🤝, and lead with optimism and compassion 🌞. These values guide everything we do.
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