Payer Credentialing Specialist
knownwell
Administration
Remote
USD 55k-65k / year
Posted 6+ months ago
👋 Meet knownwell, weight-inclusive healthcare for all. Join a dynamic company that is changing the way obesity care is delivered. We offer weight management, primary care, nutrition counseling, and health coaching. Our care model combines in-clinic and virtual care to bring support to patients where and when they need it.
Backed by $50M in funding—including a $25M round led by CVS Health Ventures with support from a16z Bio + Health, Flare Capital, MassMutual, and Intermountain Ventures—we’re scaling fast and expanding access to evidence-based obesity care nationwide.
To achieve our ambitious goals, we're looking for a Payer Credentialing Specialist to join our Operations team. This role will support all things credentialing at knownwell, and play a critical role in building, shaping, and scaling our network so that all Americans have access to our services.
The ideal candidate is a managed care expert who has a successful track record in efficiently credentialing providers across a number of geographies. You will be most successful in this role if you have an ownership mindset, strong attention to detail, and a knack for managing multiple priorities.
You will:
- Manage end-to-end credentialing and recredentialing processes for new and existing providers, including verification of education, training, board certifications, and work history.
- Coordinate payer enrollment applications and updates to ensure timely processing and provider participation across commercial and government payers.
- Maintain accurate and up-to-date credentialing files and records in compliance with internal standards and regulatory requirements.
- Collaborate with providers, health plans, and internal departments to resolve any credentialing-related issues or delays.
- Track credentialing timelines and proactively follow up on outstanding applications or documentation.
- Ensure compliance with NCQA, CMS, state, and payer-specific regulations and standards.
- Participate in audits, surveys, and reporting related to provider credentialing and enrollment.
- Support cross-functional teams including clinical operations, revenue cycle, and human resources with credentialing-related information and processes.
You have:
- Minimum of 2 years of experience in provider credentialing and payer enrollment, preferably in a multi-state medical group or healthcare organization.
- Strong knowledge of CAQH, NPPES, PECOS, and insurance payer enrollment processes.
- Familiarity with credentialing standards from NCQA, The Joint Commission, and CMS.
- High level of accuracy and attention to detail.
- Excellent communication and interpersonal skills.
- Ability to work independently, manage multiple priorities, and meet deadlines in a fast-paced environment.
Pay & Perks:
💻 Fully remote opportunity
🩺 Medical, dental, and vision insurance
📈 401K retirement plan with company match
🏝️ Up to 20 days of PTO per year + company holidays
👶 Up to 14 weeks of parental leave (12 for non-birthing parents)
🏡 Annual work from home stipend for remote employees
knownwell, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training. Based on current size of the clinic and HIPAA regulation, providers cannot receive care in clinic and provider’s household members cannot receive primary care in the clinic.
55000 - 65000 USD a year