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Credentialing and Health Insurance Specialist
RightSite HealthCredentialing and Health Insurance Specialist managing provider licensing, renewals, and health-plan participation. Supporting compliant revenue-cycle operations for RightSite Health’s EMS telehealth care-navigation model.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in provider licensing and credentialing processes, including health plan network participation and compliance with state and federal regulations. Proficient in managing provider onboarding, maintaining accurate records, and optimizing revenue cycles.
Highest-signal resume keywords
Provider OnboardingLicensing and CredentialingHealth Plan NetworksRegulatory ComplianceData Analysis
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Provider LicensingCredentialingMedicareMedicaidHealth Plan ApplicationsRegulatory SystemsData ManagementPolicy DevelopmentRevenue Cycle OptimizationCompliance Standards
Soft Skills
Meticulous AccuracyEffective CommunicationProblem Solving
Tools & Technologies
CAQHNPPESPECOSAvailityBilling SoftwareElectronic Health Record Systems
Industry Keywords
Healthcare AdministrationProvider TypesNurse CompactHIPAA RegulationsState and Federal Requirements
About the role
Key responsibilities & impact- Manage all aspects of the provider licensing and credentialing process, including health plan network participation across multiple states
- Onboard new providers through IMLC, licensure, Medicare, Medicaid, and DEA processes
- Maintain and verify provider information on CAQH, NPPES, PECOS, Availity, and other external sites
- Manage provider renewals involving IMLC, licensure, and Nurse Compact requirements
- Handle health plan applications, follow-up, contracting, and credentialing for fee-for-service arrangements
- Maintain health plan credentialing requirements and specific training requirements
- Manage databases, effective-date inputs, and passwords
- Support billing partners with effective dates, passwords, and health plan issues
- Develop policies and procedures for physician credentialing and contracting
- Communicate with Operations to support provider scheduling
- Optimize revenue cycles, ensure compliance with state and federal regulations, and contribute to the organization’s financial health
Requirements
What you’ll need- Bachelor’s degree in healthcare administration, business, or related field or equivalent work experience
- Minimum 2 years of experience in provider onboarding
- Proficiency in health plan networks
- Strong knowledge of licensing, credentialing, Medicare, and Medicaid
- Familiarity with HIPAA regulations and privacy standards
- Comprehensive knowledge of provider licensure and credentialing across multiple states and provider types
- Understanding of external regulatory systems, state and federal requirements, and regulatory compliance
- Meticulous accuracy when handling provider information, licensure data, and records
- Ability to analyze complex licensure issues, identify discrepancies, and develop effective solutions
- Proficiency in clearly communicating complex licensure and credentialing issues to Operations
- Strong aptitude for using and adapting to billing software, electronic health record systems, and data analysis tools
Benefits
Comp & perks- The opportunity to be a part of a dynamic, mission-driven organization
- Competitive base salary
- Market-competitive healthcare coverage, including medical, dental, vision, life, and disability
- The opportunity to work alongside talented and professional colleagues with the ability to grow