Credentialing Specialist

Company Description

TechLoom Global connects industry-leading companies across various sectors with top-tier global talent. Our expertise spans a wide range of functions, including sales development, product and engineering, marketing, operations, customer success, finance, and administrative support. As a TechLoom Global team member, you become part of a network of high-caliber professionals delivering real impact for forward-thinking companies navigating today's dynamic and competitive landscape.

Role Description

We are seeking a Credentialing Specialist to support a U.S.-based behavioral health organization focused on expanding access to high-quality mental health care. This is a non-clinical, operations-focused role responsible for managing the end-to-end credentialing and enrollment lifecycle for healthcare providers across a multi-state footprint. You will own provider applications from intake through activation, proactively driving submissions to completion and ensuring no credentials lapse. This role is ideal for someone with deep payer-specific knowledge, strong organizational discipline, and the ability to navigate the nuances of both state Medicaid programs and commercial insurance plans in a fully remote environment.

Responsibilities:

• Manage end-to-end provider enrollment and credentialing with Medicaid (state and MCO level), Medicare, and commercial payers across multiple states including AZ, CO, MA, MI, MO, NY, OH, and VA
• Maintain and update CAQH and PECOS profiles for all providers, ensuring accuracy and timely attestations
• Identify the correct application forms for each state Medicaid program and source them from the appropriate channels
• Proactively follow up with payers to push applications to active/effective status, including direct outreach to plan contacts
• Collect required provider documentation including licensure, NPI, taxonomy codes, W-9s, and attestations
• Manage re-credentialing and revalidation timelines to ensure zero lapsed credentials or missed deadlines
• Maintain roster integrity so no provider is unable to bill due to an expired or incomplete credential
• Track and report on key performance metrics including time-to-submit, time-to-completion, and application error/rejection rates

Qualifications:

• 3–6 years of end-to-end credentialing and provider enrollment experience
• Demonstrated experience with Medicaid (state and MCO), Medicare, and commercial payer credentialing across multiple states
• Strong working knowledge of CAQH and PECOS profile management
• Familiarity with state-specific Medicaid form requirements and how to locate and obtain them
• Experience building payer relationships and knowing who to contact to accelerate application processing
• Knowledge of licensure requirements and re-credentialing/revalidation workflows
• Skilled at collecting and organizing provider documentation (NPI, taxonomy, W-9, licensure, attestations)
• Strong written English communication skills; comfortable drafting professional correspondence
• Highly organized with the ability to manage multiple provider timelines simultaneously without missing deadlines
• Comfortable working independently in a fully remote, async-friendly environment
• Proficiency in Google Workspace; Airtable experience a strong plus