The Senior Credentialing & Provider Enrollment Specialist will drive Carepatron’s end-to-end credentialing and payer enrollment operations, ensuring providers are verified, compliant, and enrolled quickly so they can deliver care and get reimbursed without delay. While this role is initially hands-on—focusing on executing day-to-day credentialing and enrollment workflows—we are looking for someone with leadership experience who can help establish best practices and quickly transition into leading the credentialing team as our services scale.

This is a key role for a seasoned credentialing professional who thrives in a fast-growing, product-driven SaaS environment, is highly tech-savvy, embraces AI to work smarter, and is ready to step into a formal leadership position in the near future.

🎯 What You’ll Do

• Execute & Optimize: Manage daily, hands-on credentialing and enrollment workflows including primary source verification, initial credentialing and re-credentialing, payer enrollment applications, revalidations, and CAQH profile maintenance.
• Own Provider Enrollment: Enroll and maintain providers across Medicare (PECOS), Medicaid, and commercial payers, and manage NPI/NPPES records so practices can bill and get reimbursed as fast as possible.
• Prepare for Leadership: Act as the primary subject matter expert, laying the groundwork to quickly transition into mentoring, training, and managing the credentialing and enrollment team as it expands.
• Embrace AI & Automation: Actively use AI tools and modern software to streamline your own daily workflows, reduce manual data entry, track expirations and revalidations, and build highly efficient, scalable processes for the future team.
• Product Collaboration: Partner with our product and engineering teams to refine automated credentialing workflows, enrollment tracking, and AI-driven credentialing intelligence features.
• Improve Operations: Drive improvements across credentialing workflows to shorten enrollment turnaround times, prevent lapses, and reduce revenue loss caused by credentialing delays.
• Troubleshoot & Support: Resolve complex credentialing and enrollment issues, chase down payer approvals, and provide escalation support to our customers and internal teams.
• Track Performance: Own and report on key performance metrics, including enrollment turnaround times, application approval rates, revalidation timeliness, and expiring credential tracking.
• Compliance: Ensure all credentialing operations meet HIPAA, CMS, NCQA, and TJC/JCAHO standards as well as payer-specific requirements.

🧠 What You Bring

• 5+ years of US provider credentialing and payer enrollment experience, with a proven track record of managing end-to-end credentialing and enrollment cycles.
• Previous experience in a lead, supervisory, or senior role, with a strong desire to return to or step up into formal team management quickly.
• Tech-Savvy & AI Proficient: You are highly comfortable with modern technology and adapt quickly to new software. You know how to leverage AI tools (e.g., ChatGPT, automated workflows, AI assistants) to increase efficiency and solve problems.
• Deep knowledge of primary source verification, CAQH, PECOS, NPPES, payer enrollment portals, re-credentialing cycles, and complex application resolution.
• Working knowledge of NCQA, TJC/JCAHO, and CMS regulatory standards and payer-specific requirements.
• Hands-on experience with credentialing platforms such as CAQH, VerityStream, MD-Staff, or Symplr.
• Experience with behavioral health, primary care, PT/OT, or multi-specialty credentialing (highly valued).
• CPCS or CPMSM certification (NAMSS) is a strong plus.
• Demonstrated ability to improve credentialing operations through process optimization or automation.
• Exceptional communication skills, with the ability to guide providers, payers, and internal teams through complex credentialing requirements.
• A collaborative mindset and comfort working in a fast-paced SaaS environment.
• Familiarity with Carepatron or modern EHR/practice management tools is a plus.

💙 Why You’ll Love Working at Carepatron

• Clear Career Acceleration: A direct and rapid path to transition into a formal leadership and management role as our credentialing division grows.
• Mission-Driven Culture: Work with a team dedicated to improving the daily lives of healthcare professionals.
• Flexible Working: A remote-first culture with flexible arrangements.
• Build the Future: Work alongside world-class product designers, engineers, and operators to shape modern, AI-powered healthcare software.
• Competitive Package: Compensation tailored to your experience, with performance incentives.