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FlyteHealth is a cardiometabolic care provider treating obesity, prediabetes, hypertension, and hyperlipidemia through integrated care combining behavioral lifestyle modification with clinical intervention. The company operates a multi-state virtual clinical network and is seeking a Provider Enrollment & Credentialing Specialist to build and operate a centralized, scalable credentialing function.
In this hands-on role, you will own day-to-day provider licensing, credentialing, re-credentialing, enrollment readiness, and compliance workflows while maintaining NCQA standards and FlyteHealth policy. You will work directly with clinicians, state licensing boards, payors, the credentialing verification organization (CVO), and internal teams across Clinical Operations, Legal, Compliance, Finance, and People.
Key responsibilities include:
**Licensing, Credentialing & Enrollment**: Execute end-to-end provider licensing, renewals, re-credentialing, and payer enrollment (CAQH, Medicare/Medicaid) across all states. Maintain the single source of truth for provider-by-state readiness covering licenses, DEA and controlled-substance registrations, malpractice coverage, attestations, CME, and state-specific requirements. Monitor expirations on advance intervals (120/90/60/30 days) and resolve missing information, aging applications, and blockers before they become urgent. Ensure no clinician is scheduled or practices in any jurisdiction where required authorization cannot be verified.
**Provider Onboarding & Readiness**: Own the workstream from provider acceptance through ready-to-practice status. Keep Clinical Operations and People current on status and anything that could delay onboarding or patient access. Drive clinician outreach for outstanding documentation using clear provider-facing checklists and timelines.
**NCQA & Audit Readiness**: Translate NCQA credentialing and re-credentialing standards into workflows, policies, and SOPs. Keep all files, evidence, committee records, and required review cycles audit-ready year-round. Partner with Legal, Compliance, and external experts to remediate findings and support delegated credentialing and payer audits.
**Credentialing Committee & Reporting**: Run the monthly Credentialing Committee including agenda, files, approvals, exceptions, and minutes. Produce Red/Amber/Green dashboards covering risk, expirations, open applications, re-credentialing, turnaround time, and vendor performance. Assign every exception an accountable owner and due date; escalate before items create patient-care, compliance, or scheduling risk.
**Vendor & CVO Management**: Serve as operational point person for FlyteHealth's CVO and credentialing platforms. Reconcile vendor data against internal records, hold vendors to service levels, and drive open issues to closure. Inform build-versus-buy decisions and budget forecasting through reliable visibility into provider seats, licenses, renewals, and credentialing demand.
Success means no surprises—every clinician, state, and expiration is visible and actioned before it becomes urgent. Clinical Operations always knows when a provider will be ready to practice and what's blocking progress. NCQA evidence is audit-ready every day of the year, and processes support network, state, and payer expansion without proportional growth in administrative complexity.
**Requirements:**
- 3+ years of hands-on credentialing, provider enrollment, medical staff services, or CVO experience in a multi-provider environment
- NCQA credentialing and re-credentialing experience applied in day-to-day operations (required)
- Multi-state licensure management, including state-specific requirements and ongoing compliance monitoring
- Fluency with credentialing documentation: primary-source verification, CAQH, NPDB, OIG/SAM checks, malpractice coverage, work history, education/training, and board certification
- Proven ability to manage high-volume, deadline-driven work with exceptional follow-through, communicating directly with clinicians, state boards, payors, vendors, and internal leaders
- Comfort building dashboards, trackers, SOPs, committee packets, and audit files leadership can trust; able to identify risk and independently drive issues to resolution
**Preferred Qualifications:**
- Payer enrollment with commercial payors, Medicare, Medicare Advantage, and/or Medicaid
- Experience in a multi-state virtual-care, medical-group, MSO, or affiliated professional-entity model
- Experience supporting NCQA accreditation/certification, delegated credentialing, or payer credentialing audits
- Medallion or another modern credentialing platform; knowledge of DEA and controlled-substance registration workflows
- CPCS, CPMSM, or other recognized credentialing/medical staff services certification
