Healthcare Licensing and Credentialing (Clarity)

Summary:
Responsible for verifying provider licensing and credentials, managing payer enrollment, and ensuring compliance with healthcare standards. Supports timely credentialing and re-credentialing for providers.

Responsibilities:

• Collect and verify provider documents (licenses, education, certifications, malpractice, etc.).
• Process credentialing and re-credentialing applications with payers (Medicare, Medicaid, commercial plans).
• Maintain provider files, databases, and systems (e.g., CAQH, NPPES, PECOS).
• Track expirations and ensure timely renewals.
• Communicate application status and requirements to providers and internal teams.
• Ensure compliance with HIPAA, NCQA, Joint Commission, and other regulations.

Qualifications:

• Experience in healthcare credentialing or provider enrollment preferred.
• 2+ years in Behavioral Health credentialing
• Experience working in Modio credentialing database
• Knowledge of CAQH, PECOS, and payer requirements is an advantage.
• Strong attention to detail, organization, and communication skills.
• Proficient with Microsoft Office and credentialing systems.
• Willing to work US hours from Monday to Friday

Summary: Responsible for verifying provider licensing and credentials, managing payer enrollment, and ensuring compliance with healthcare standards. Supports timely credentialing and re-credentialing for providers.Responsibilities: Collect and verify p...

Summary:
Responsible for verifying provider licensing and credentials, managing payer enrollment, and ensuring compliance with healthcare standards. Supports timely credentialing and re-credentialing for providers.

Responsibilities:

• Collect and verify provider documents (licenses, education, certifications, malpractice, etc.).
• Process credentialing and re-credentialing applications with payers (Medicare, Medicaid, commercial plans).
• Maintain provider files, databases, and systems (e.g., CAQH, NPPES, PECOS).
• Track expirations and ensure timely renewals.
• Communicate application status and requirements to providers and internal teams.
• Ensure compliance with HIPAA, NCQA, Joint Commission, and other regulations.

Qualifications:

• Experience in healthcare credentialing or provider enrollment preferred.
• 2+ years in Behavioral Health credentialing
• Experience working in Modio credentialing database
• Knowledge of CAQH, PECOS, and payer requirements is an advantage.
• Strong attention to detail, organization, and communication skills.
• Proficient with Microsoft Office and credentialing systems.
• Willing to work US hours from Monday to Friday

Summary: Responsible for verifying provider licensing and credentials, managing payer enrollment, and ensuring compliance with healthcare standards. Supports timely credentialing and re-credentialing for providers.Responsibilities: Collect and verify p...