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Salary: USD 65,000 - 75,000 / annual
Oshi Health, a virtual digestive health practice, is seeking a Licensing and Credentialing Specialist to manage end-to-end payer enrollment and provider credentialing operations. This role is critical to ensuring providers are enrolled, credentialed, and ready to deliver care across the organization's growing network.
Key Responsibilities:
- Own the complete payer enrollment lifecycle for new and existing providers, including initial enrollments, revalidations, demographic updates, terminations, and maintenance across commercial, Medicare, and Medicaid health plans.
- Submit, track, and proactively follow up on payer enrollment applications to minimize delays to patient care and revenue.
- Serve as primary point of contact with national and local health plans, delegated credentialing organizations, CVOs, and internal stakeholders to resolve enrollment issues and payer escalations.
- Maintain accurate provider data across payer portals, CAQH, credentialing systems, and internal tracking tools, ensuring consistency across all platforms.
- Support delegated credentialing activities by maintaining provider rosters, submitting required updates, monitoring compliance, and preparing documentation for audits.
- Conduct routine audits of provider enrollment and credentialing files to ensure compliance with NCQA, CMS, state, and payer-specific requirements.
- Monitor key enrollment and credentialing metrics, identify risks to provider participation, and communicate status updates to leadership and cross-functional partners.
- Collaborate with Licensing, Practice Operations, Revenue Cycle, Recruiting, and Clinical Operations teams to ensure providers are fully credentialed and ready to see patients on schedule.
- Identify opportunities to improve enrollment and credentialing workflows through process standardization, documentation, and automation.
- Support provider licensing activities, including coordinating new state license applications, renewals, cross-licensure efforts, and maintaining accurate licensure records.
- Monitor provider licenses, DEA and CDS registrations, board certifications, malpractice coverage, and other required credentials to ensure continuous compliance.
- Provide exceptional support to providers throughout the enrollment, credentialing, and licensing process.
The ideal candidate is highly organized, detail-oriented, and thrives in a fast-paced environment. They are proactive in identifying and resolving issues, communicate effectively with internal and external stakeholders, and are passionate about creating efficient, scalable processes that support organizational growth while maintaining regulatory compliance.
Requirements:
Required: Bachelor's degree in Healthcare Administration or related field; 3+ years of experience in provider payer enrollment and credentialing; experience managing provider enrollments with commercial, Medicare, and Medicaid payers; experience supporting delegated credentialing activities including provider rosters, ongoing monitoring, or audit preparation; experience with multi-state or national provider organizations; working knowledge of CAQH, payer portals, and provider credentialing systems; understanding of NCQA, CMS, state licensing, and payer credentialing requirements; strong organizational skills with ability to manage multiple priorities and deadlines; excellent attention to detail and written and verbal communication skills; proficiency with Google Workspace, including Google Sheets.
Preferred: Certified Provider Credentialing Specialist (CPCS) certification or equivalent credential; 1+ year working in Verifiable Enrollment and Licensing Manager; experience supporting delegated credentialing audits and corrective action plans; familiarity with provider licensing and cross-state licensure; experience working with credentialing vendors (CVOs); experience in a virtual care or telehealth environment; experience working in a fast-paced, high-growth startup environment; process improvement mindset with experience documenting or streamlining workflows.
