Contracting And Credentialing Specialist

Overview

We are seeking a Contracting & Credentialing Specialist to build and maintain our payer contract portfolio and ensure our growing clinician roster is fully credentialed and licensed across multiple states. In this high-impact, independent contributor role, you will own the full contracting lifecycle and manage compliance workflows that directly drive our revenue growth. If you are a self-motivated professional with deep expertise in healthcare credentialing and payer relationships, this is a prime opportunity to make a measurable impact.

Schedule

• Full Time | Monday-Friday, 9 am – 5 pm Needham Heights, MA Time | 40 hours per week

Responsibilities

Payer Contracting

• Identify, initiate, and manage contracting relationships with commercial payers, Medicaid MCOs, and Medicare Advantage plans across all active states
• Submit and track contract applications through payer portals and credentialing systems (CAQH, PECOS, state-specific portals)
• Negotiate fee schedules and contract terms in coordination with the Director of US Services
• Maintain a complete, current database of contracted payers by state and discipline
• Monitor contract status, renewal dates, and required re-attestations to prevent lapses in payer participation
• Coordinate with billing to ensure new contracts are loaded correctly in Athelas and claims can be processed

Clinician Credentialing

• Manage initial credentialing and re-credentialing for all clinicians (OT, PT, SLP, LCSW, NP) across all payer panels
• Maintain CAQH profiles and ensure attestations are completed on schedule for all providers
• Track credentialing status by clinician, payer, and state in a centralized tracker; flag pending approvals and gaps
• Coordinate with clinicians to collect and verify required credentialing documents (NPI, DEA, malpractice, education, references)
• Liaise with payers to follow up on pending applications and resolve credentialing issues proactively
• Manage enrollment in Medicare Part B by state as new clinicians are added or new states are activated

License Management

• Track all active clinician licenses across states, including expiration dates, CE requirements, and renewal timelines
• Send timely renewal reminders and coordinate license renewal workflows so no clinician practices with a lapsed license
• Research and initiate new state licensure applications as the business expands into new markets
• Maintain a current, audit-ready record of all licenses for each provider discipline

Compliance & Administration

• Ensure contracting and credentialing practices comply with state telehealth regulations, payer-specific requirements, and HIPAA
• Support due diligence requests from investors or auditors related to provider enrollment and payer contracts
• Maintain documentation standards consistent with the companys MSO-PC structure and physician oversight model

Requirements

Required:

• 3+ years of experience in provider credentialing, payer contracting, or revenue cycle operations in a healthcare setting
• Hands-on experience with CAQH ProView and PECOS enrollment
• Demonstrated success managing credentialing for multiple providers simultaneously across multiple payers
• Working knowledge of Medicare Part B enrollment processes by state and specialty
• Experience with telehealth or multi-state practice models preferred
• Strong organizational skills and ability to manage complex, deadline-driven workflows independently
• Proficiency with spreadsheets and data tracking; experience with EHR or credentialing software a plus

Preferred:

• Experience contracting with Medicaid MCOs or Medicare Advantage plans
• Familiarity with PT, OT, SLP, social work, or NP credentialing requirements
• Background in a startup or high-growth healthcare environment
• Familiarity with MSO-PC corporate structures

Independent Contractor Perks

• Permanent work from home
• Immediate hiring
• Health Insurance Coverage for eligible locations

Note

Please click the Apply button to complete your application, including the assessment questions, technical check, and voice recording. Your hourly pay rate will be established based on your performance in the application process; submissions with all requirements fulfilled will receive priority review.

(55974851769)