Payor Credentialing Specialist
Remote
Growth /
Full-time /
Remote
Meet knownwell, weight-inclusive healthcare for all. Join a dynamic company that is changing the way care is delivered for patients with obesity. knownwell is a weight-inclusive healthcare company offering metabolic health services, primary care, nutrition counseling and health coaching services for anyone of any size. Our hybrid model allows for both in-clinic and virtual care to bring support to patients where and when they need it. To learn more about our recent Series A funding, led by Andreessen Horowitz, please check out this article.
To achieve our ambitious goals, we're looking for a Payor Credentialing Specialist to join our Growth team. This role will play a critical role in building, shaping and scaling our network so that all Americans have coverage to get services from knownwell. This person will support all things credentialing at knownwell.
The candidate that will achieve the greatest success will be a seasoned managed care expert, who has a successful track record in swiftly credentialing providers across a number of geographies.
Responsibilities:
- Manage end-to-end credentialing and recredentialing processes for new and existing providers, including verification of licensure, education, training, board certifications, and work history.
- Coordinate payer enrollment applications and updates to ensure timely processing and provider participation across commercial and government payers.
- Maintain accurate and up-to-date credentialing files and records in compliance with internal standards and regulatory requirements.
- Collaborate with providers, state licensing boards, health plans, and internal departments to resolve any credentialing-related issues or delays.
- Track credentialing timelines and proactively follow up on outstanding applications or documentation.
- Ensure compliance with NCQA, CMS, state, and payer-specific regulations and standards.
- Participate in audits, surveys, and reporting related to provider credentialing and enrollment.
- Support cross-functional teams including clinical operations, revenue cycle, and human resources with credentialing-related information and processes.
Requirements:
- Minimum of 2 years of experience in provider credentialing and payer enrollment, preferably in a multi-state medical group or healthcare organization.
- Strong knowledge of state licensing requirements, CAQH, NPPES, PECOS, and insurance payer enrollment processes.
- Familiarity with credentialing standards from NCQA, The Joint Commission, and CMS.
- High level of accuracy and attention to detail.
- Excellent communication and interpersonal skills.
- Ability to work independently, manage multiple priorities, and meet deadlines in a fast-paced environment.
$60,000 - $70,000 a year
We offer a comprehensive benefits package (Medical, Dental, Vision, 401k match, PTO), competitive salary and the opportunity to be part of a purpose-driven organization that is dedicated to making a positive impact on the lives of patients. If you are an ambitious and experienced clinician who is passionate about transforming healthcare and creating meaningful change, we invite you to apply and join our dynamic team. Please send us a note at hiring@knownwell.health.
knownwell, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training. Based on current size of the clinic and HIPAA regulation, providers cannot receive care in clinic and provider’s household members cannot receive primary care in the clinic.
