Credentialing and Enrollment Specialist

Credentialing Specialist - Remote

About AllerVie Health

At AllerVie Health, our team members are unified around our mission to help patients achieve and maintain optimal health and quality of life - free from the symptoms and suffering of allergies, asthma, and related immunological conditions. From our physician and clinical roles to our administrative and operational support roles and everything in between, we change lives for the better - giving people their lives, health, and vitality back in real, tangible ways. We live every day on a mission and wake up excited to tackle new challenges and provide people with health solutions.

Job Summary

The Credentialing Specialist plays a critical role in supporting all aspects of provider credentialing and re-credentialing to ensure timely, accurate enrollment with insurance payers. In this fast-paced environment, this role requires a proactive problem solver who can think critically, manage competing priorities, and collaborate effectively with cross-functional teams. Responsibilities include verifying provider information, maintaining credentialing databases, submitting applications through payer portals, and serving as a key resource for internal and external stakeholders regarding credentialing status and payer access.

Key Responsibilities

Credentialing & Enrollment

• Prepare, submit, and track initial and re-credentialing applications for healthcare providers.
• Verify and maintain accurate provider information (licenses, certifications, education, work history, etc.).
• Proactively monitor expiration dates and ensure timely updates to prevent lapses in participation.
• Anticipate and resolve barriers to enrollment by proactively communicating with payers and internal stakeholders.
  
  

Payer Portal & System Management

• Manage payer portal access for staff and external resources, including setup, maintenance, and troubleshooting.
• Update provider rosters, demographics, and other required data in payer portals.
• Serve as the primary contact for payer portal inquiries and access-related issues.
• Identify and escalate system errors, access delays, or portal inefficiencies to prevent disruptions.
  
  

Compliance & Quality Assurance

• Ensure all credentialing activities comply with regulatory, payer, and accreditation requirements.
• Maintain accurate and up-to-date credentialing files, databases, and documentation.
• Conduct periodic audits of credentialing records to identify and resolve discrepancies.
• Stay informed of changes in payer rules, regulations, or credentialing requirements and adjust processes accordingly.
  
  

Communication & Collaboration

• Provide timely updates to providers, practice managers, and internal teams regarding credentialing and enrollment status.
• Act as a problem solver by addressing payer and provider inquiries quickly and effectively.
• Partner with revenue cycle, operations, and clinical teams to resolve credentialing issues that impact business operations.
• Build strong relationships with payers to expedite issue resolution and maintain positive working partnerships.
  
  

Reporting & Continuous Improvement

• Track application status and payer enrollments, preparing regular progress reports for leadership.
• Monitor timelines to ensure applications are submitted and completed within payer deadlines.
• Identify process inefficiencies and recommend improvements to enhance accuracy, efficiency, and turnaround times.
• Contribute to the development of standard operating procedures (SOPs) and best practices for credentialing.
  
  

Qualification, Educations, Experience

• Associate’s or Bachelor’s degree in Healthcare Administration, Business Administration, or related field preferred.
• Equivalent combination of education and relevant experience considered.
• Minimum 1–2 years of experience in healthcare credentialing and provider enrollment required.
• Experience working with payer portals, insurance enrollment, or regulatory compliance strongly preferred
• Background in multi-site healthcare operations or medical office administration a plus.
• Critical thinking and problem-solving skills with the ability to identify issues, troubleshoot, and resolve credentialing challenges.
• Strong time management skills; able to handle competing priorities and meet tight deadlines in a high-volume, fast-paced environment.
• Adaptability and resilience when faced with changes in payer requirements, deadlines, or processes.
• Analytical mindset to track application progress, identify bottlenecks, and improve workflows.
• Collaboration and teamwork skills; able to partner effectively with providers, managers, payers, and internal departments.
• Proficiency with credentialing databases or systems (e.g., CAQH, NPPES, payer portals); ability to quickly learn new systems and tools.
  
  

When you join AllerVie Health, you become part of a purpose-driven team dedicated to transforming lives through compassionate allergy care. We recognize and value the experience, perspective, and commitment you bring to our mission. In return, we offer competitive compensation and comprehensive benefits that empower you to thrive. This support enables you to give your best to the patients who count on us every day.

Benefits

• Medical, Dental, and Vision Insurance Plans
• Employer HSA contribution
• Employer-Paid Life Insurance
• Supplemental benefit offerings
• 401(k) Plan with employer match
• Generous PTO and paid holidays
  
  

Learn About Us

LinkedIn: https://www.linkedin.com/company/allervie-health/posts/?feedView=all

Instagram: https://www.instagram.com/allerviehealth/

AllerVie Health is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.