Credentialing Specialist

Description

The Credentialing Specialist plays a critical role in supporting Turnwell’s mission by ensuring that all providers are credentialed, re-credentialed, and enrolled with payors efficiently and accurately. This role works closely with internal teams and external partners to maintain compliance with regulatory and accreditation standards and supports a high-performing provider onboarding experience. 

Responsibilities:

• Coordinate and manage end-to-end initial credentialing, re-credentialing, and payor enrollment processes for new and existing providers across multiple states.
• Prepare and submit credentialing and enrollment applications to commercial insurance payors, Medicare, and Medicaid.
• Maintain accurate and up-to-date provider data in credentialing databases (e.g., CAQH, NPPES, PECOS).
• Track and follow up on application statuses; proactively resolve discrepancies or delays with payors.
• Ensure compliance (as appropriate) with NCQA, Joint Commission, CMS, and state licensing board standards.
• Collaborate with HR, recruitment, and operations to ensure smooth provider onboarding and readiness to bill.
• Maintain digital credentialing files and documentation, ensuring data integrity across systems.
• Respond to payor audits, verifications, and recredentialing notices in a timely manner.
• Identify opportunities for process improvement and assist in building scalable credentialing workflows.
• Assist with special projects as needed, including support for acquisitions, new markets, and delegated credentialing contracts.

Requirements

Required:

• 2+ years of experience in provider credentialing and/or payor enrollment, preferably in behavioral health or multi-state environments
• Working knowledge of Medicare, Medicaid, and commercial insurance payor processes
• Familiarity with systems such as CAQH, PECOS, NPPES, and payor-specific portals
• Strong organizational skills with exceptional attention to detail and accuracy
• Ability to manage multiple priorities and meet deadlines independently
• Excellent written and verbal communication skills
• High level of professionalism and discretion with confidential information

Preferred:

• Experience credentialing psychiatrists, psychologists, therapists, and NPs
• Knowledge of NCQA, URAC, or The Joint Commission standards
• Experience in a growth-stage healthcare organization or MSO
• Associate’s or bachelor’s degree in health administration or related field