Credentialing Specialist

Be Part of Something Radically Different. At Holon Health, we don’t do “business as usual.” We’re a trailblazing healthcare startup reimagining what it means to care, for our clients and our people. We provide whole‑person care to justice‑involved individuals living with Substance Use Disorder (SUD), and we do it with deep compassion, community wisdom, and an unshakable belief in second chances. Our approach throws out the playbook: we integrate medical, behavioral, and social care, prioritize prevention and recovery, and treat clients like people, not checkboxes. We lead with flexibility, trust, and a culture built on well‑being, inclusion, and respect.

About the Role

Holon Health is seeking a Credentialing Specialist to support and safeguard the work that lets our providers deliver care. This role owns provider onboarding, credentialing, recredentialing, licensure management, and payer enrollment across multiple states, keeping our clinicians enrolled and maintained with commercial, Medicare, and Medicaid payers while staying compliant with regulatory, accreditation, and organizational requirements. The ideal candidate is organized, resourceful, and comfortable managing many moving pieces at once, working closely with providers, health plans, regulatory agencies, and internal teams.

Responsibilities

• Coordinate initial credentialing, recredentialing, and payer enrollment for physicians, advanced practice providers, and other licensed clinicians.
• Manage Medicare, Medicaid, and commercial payer enrollment applications across multiple states.
• Perform primary source verifications and revalidations in line with payer, regulatory, and accreditation requirements.
• Submit and manage provider demographic updates, location additions, participation requests, and other enrollment changes.
• Monitor applications through completion and proactively follow up with payers to resolve delays or discrepancies.
• Maintain the accuracy and integrity of provider credentialing files, databases, and reporting systems.
• Update external credentialing databases and portals, including CAQH, PECOS, NPPES, Availity, and state enrollment systems.
• Track and manage expirations for licenses, DEA registrations, malpractice insurance, board certifications, attestations, and other time‑sensitive credentials.
• Ensure provider records comply with Holon Health policies, NCQA standards, CMS requirements, and state and federal regulations.
• Prepare and maintain documentation for audits, accreditation reviews, and payer credentialing requests.
• Support provider onboarding and new market expansion efforts.
• Maintain provider rosters and coordinate submissions to participating health plans.
• Respond to credentialing inquiries from providers, health plans, regulatory agencies, and internal stakeholders.
• Manage credentialing inboxes and daily workflows, including approvals, denials, appeals, and payer correspondence.
• Partner with Operations, Leadership, Contracting, and Compliance teams to support shared goals.
• Identify process improvements that increase efficiency, accuracy, and turnaround times.

Success Indicators

• Credentialing and enrollment applications are completed accurately and submitted on time.
• Provider records stay current, compliant, and audit‑ready.
• Enrollment delays are identified and resolved proactively.
• Expiring credentials are tracked and renewed before deadlines.
• Credentialing processes continuously improve in accuracy, efficiency, and turnaround time.

Requirements

• At least five (5) years of experience in healthcare credentialing, provider enrollment, medical staff services, or a related area.
• Bachelor’s degree in Healthcare Administration, Business Administration, or a related field preferred; equivalent experience considered.
• Strong knowledge of credentialing and recredentialing, payer enrollment workflows, and primary source verification.
• Experience with Medicare, Medicaid, and commercial health plans, managing credentialing and enrollment across multiple states.
• Proficiency with credentialing systems, provider portals, and Microsoft Office.
• Excellent organizational skills with strong attention to detail and follow‑through.
• A dependable sense of ownership and accountability for accurate, audit‑ready work.
• Ability to manage multiple priorities and meet deadlines in a dynamic environment.
• Clear written and verbal communication; ability to work professionally with providers, payers, and internal teams.

Nice to Have

• Experience with Modio or another credentialing database.
• Experience with telehealth or integrated healthcare models.
• Experience developing and implementing delegated credentialing processes.

Pay

Base salary of $60–$65k.

Schedule