Junior Provider Enrollment and Credentialing Specialist

Description:

Title: Junior Provider Enrollment and Credentialing Specialist
Reports to: Head of Payer Strategy
Department/Location: Remote
FLSA Status: Exempt
Travel Requirement: Minimal

Guidelight Health provides insurance-based intermediate levels of care that are structured, transformative, personalized and accessible. Guidelight is an Equal Opportunity Employer. We're passionate about fostering an environment where everyone, irrespective of their race, gender, sexual orientation, or background, feels valued and included.

Summary:
The Junior Provider Enrollment and Credentialing Specialistplays a vital support role in ensuring healthcare providers are accurately enrolled with insurance payers and credentialed according to organizational and regulatory standards. This entry-level position is ideal for candidates looking to build a career in healthcare administration, compliance, or medical staff services.

Responsibilities:

• Assist in the preparation, submission, of provider enrollment applications with government and commercial payers and manage the process until completion.
• Support the credentialing process by gathering and verifying provider information (licenses, certifications, education, work history, malpractice insurance, etc.).
• Maintain up-to-date provider data in credentialing/enrollment systems and databases.
• Track andmonitorapplication statuses and follow up with payers or providers as needed to ensuretimelyprocessing.
• Communicate with providers, internal departments, and external stakeholders to obtain or clarify required information.
• Help ensure compliance with regulatory and accreditation standards (e.g., NCQA, CMS, Joint Commission).
• Assistwith recredentialing and revalidation processes within required timelines.
• Organize andmaintainaccuratedocumentation of enrollment and credentialing activities.
• Perform routine audits of provider files andcredentialingrecords.
• Provide administrative support to the Credentialing or Provider Services team as needed.
• Report out on key development milestones to leadership team.

Qualifications:

• Education & Experience:
  
  
  
  • High school diploma or equivalent required; Associate's degree or coursework in healthcare administration or a related field preferred.
  • 1+ year of administrative experience in a healthcare setting preferred (internships or volunteer experience may be considered).
  • Exposure to provider credentialing/enrollment processes is a plus but not required.
  
  
  
  
• Skills:
  
  
  
  • Strong attention to detail and organizational skills.
  • Effective written and verbal communication skills.
  • Ability to manage multiple priorities and meet deadlines.
  • Proficiency with Microsoft Office Suite (Word, Excel, Outlook).
  • Experience with credentialing software (e.g., CAQH, PECOS, Availity) is a plus.
  • Ability to handle confidential information with discretion.