Licensing & Credentialing Specialist

CareTalk Health

Licensing & Credentialing Specialist responsible for managing provider credentialing at CareTalk Health. Ensuring compliance with CMS, NCQA, and state regulatory requirements for telehealth.

Posted 8/1/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSenior💰 $30 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Expertise in managing provider credentialing and recredentialing processes, ensuring compliance with CMS, NCQA, and state regulations. Proficient in database management and maintaining provider records while adhering to HIPAA standards.

Highest-signal resume keywords

Healthcare CredentialingCMS RegulationsCAQH ManagementMedicare EnrollmentDatabase Management

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Provider CredentialingPayer EnrollmentLicensing ManagementNCQA StandardsState-Specific RegulationsPECOS EnrollmentNPPES Management855i ApplicationsMulti-State LicensingData Integrity

Soft Skills

Organizational SkillsAttention to Detail

Tools & Technologies

ModioCredentialing DatabasesPayer Portals

Industry Keywords

HIPAA ComplianceTelehealth DeliveryCollaborative AgreementsNurse Practitioner AgreementsHealthcare Privacy Standards

About the role

Key responsibilities & impact

Manage full-cycle provider credentialing and recredentialing processes in compliance with CMS, NCQA, and state regulatory requirements
Oversee medical payer enrollment activities, ensuring timely and accurate submission of applications to commercial payers and government entities (e.g., Medicare)
Complete and manage PECOS and CMS 855i enrollments and updates
Partner with providers to maintain and update CAQH profiles to ensure accuracy and attestation compliance
Maintain and track provider records in credentialing databases, ensuring data integrity, accuracy, and confidentiality
Track and manage active licenses and expiration dates via Modio for:
Physicians and Advanced Practice Providers
Registered Nurses (RNs)
Licensed Vocational Nurses (LVNs)
Licensed Practical Nurses (LPNs)
Proactively monitor expirations and coordinate renewals via Modio to ensure uninterrupted compliance and ability to practice
Maintain working knowledge of all 50-state licensure and practice requirements impacting telehealth delivery
Research and interpret state-specific regulations, including:
Nurse Practitioner collaborative/supervisory agreement requirements
Scope of practice variations by state
Establish and maintain processes to ensure compliance with varying state laws and regulatory updates
Coordinate and manage collaborative agreements in accordance with state-specific requirements
Monitor credentialing status and proactively resolve issues or delays with payers and regulatory agencies
Conduct thorough review of credentialing applications in alignment with NCQA and accreditation standards
Maintain provider data across platforms including CAQH, NPPES, PECOS, and payer portals
Maintain comprehensive databases of provider information, ensuring accuracy and confidentiality
Handle sensitive information with strict adherence to HIPAA and healthcare privacy standards
Collaborate cross-functionally with recruiting, operations, and compliance teams to ensure timely onboarding

Requirements

What you’ll need

3+ years of experience in healthcare credentialing, licensing, and payer enrollment
Strong knowledge of CMS regulations, Medicare enrollment processes, and multi-state licensing requirements
Hands-on experience with CAQH, PECOS, NPPES, and payer portals
Experience managing 855i applications and Medicare provider enrollment workflows
Demonstrated experience tracking multi-state licensure and expirations for providers and nursing staff (RNs, LVNs, LPNs)
Experience researching and applying state-specific regulatory requirements, including NP collaborative agreements
Knowledge of credentialing standards including NCQA
Strong database management experience within credentialing systems
Exceptional organizational skills with strong attention to detail

Benefits

Comp & perks

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