Credentialing Specialist

LifeMD operates within the virtual primary care and telehealth industry, providing comprehensive treatment programs to a nationwide patient base. The organization addresses challenges in healthcare accessibility and integration by combining licensed providers across all states with in-house pharmacy and laboratory services. This vertically integrated platform leverages proprietary technology to deliver high-quality and affordable care. Recognized for rapid growth, the company is positioned at the intersection of healthcare and technology innovation.

About the Role

The Credentialing Specialist plays a crucial role in maintaining the efficiency of medical licensing, credentialing, and payer contract processes. Reporting to the Director of Payor Enrollment, Licensing & Credentialing, this position ensures that providers are properly credentialed and enrolled with insurance payors and hospitals, which supports the organization in maximizing provider effectiveness and compliance.

Responsibilities

• Credential and re-credential providers with insurance payors and hospitals.
• Maintain and update insurance credentialing and CAQH Provider System.
• Keep credentialing matrices current across providers and jurisdictions.
• Communicate regularly with insurance payors regarding credentialing status.
• Collaborate with various departments on provider onboarding and offboarding.
• Assist providers with credentialing, licensing, and payor enrollment inquiries.
• Obtain necessary licensure and privileges for providers.
• Manage and update provider credentialing rosters.
• Verify licensure, malpractice, educational credentials, and certifications.
• Ensure accuracy of payor directory listings through regular checks and updates.
• Consistently meet expectations for timely payor application submissions.
• Prepare and manage confidential administrative correspondence and documentation.
• Maintain confidentiality of provider and organizational information.
• Support special projects and data management tasks as assigned.
• Demonstrate reliability in attendance and readiness for scheduled work.
• Perform additional related duties as needed.

Requirements

• Credentialing Certification or Bachelor’s degree in Business or Healthcare Administration or equivalent experience.
• Minimum of 2 years in credentialing and administrative roles.
• Certified Provider Credentialing Specialist (CPCS), Certified Medical Services Management (CPMSM), or Certified Provider Enrollment Specialist (CPES).
• Expertise in credentialing, multi-state licensing, and payor enrollment processes.
• Strong analytical skills to interpret complex data.
• Knowledge of healthcare regulations and compliance.
• Proficiency with credentialing software and adaptability to new systems.
• Effective written, verbal, and presentation communication skills.
• Ability to thrive in a fast-paced, dynamic growth environment.
• Problem-solving skills, strategic thinking, and teamwork orientation.
• Excellent organizational skills and attention to detail.

Pay

$60,000-$70,000 annually.

Benefits

• Health Care Plan including Medical, Dental, and Vision.
• Retirement Plan including 401(k) and Roth 401(k).
• Life Insurance (Basic, Voluntary, and AD&D).
• Flexible Paid Time Off.
• Paid Holidays.
• Short Term Disability.
• Training and Development opportunities.