Credentialing & Enrollment Specialist II

We are currently seeking a Credentialing & Enrollment Specialist II to join our credentialing team as we continue to grow and provide patient services on a national scale. This role will report directly to our Manager, Credentialing and Enrollment and will serve as an experienced cross-functional operator within the team. In this role, you will manage the full range of credentialing and enrollment production work with minimal supervision, including more complex cases across the provider lifecycle. You will also serve as a resource for Credentialing Specialist I team members and may take on limited subject matter expert responsibilities to support team operations. This position represents the experienced production role within the unified credentialing and enrollment team and plays an important part in ensuring the continued growth and quality of our national provider network.

What you’ll be doing as a Credentialing & Enrollment Specialist II :

Provider Lifecycle Execution

• Execute provider onboarding readiness tasks and intake packet completeness checks
• Prepare and submit initial credentialing and re-credentialing applications
• Submit and monitor primary source verifications through CVO
• Perform PSV according to departmental policies and NCQA standards when not completed by CVO
• Review CVO-processed files for completeness and accuracy
• Process provider status changes, terminations, and reactivations
• Collect and follow up on missing provider documentation
• Track and manage provider expirables and renewal timelines

Payer Enrollment & Roster Execution

• Complete and submit group and individual enrollment applications to commercial and government payers
• Follow up on submitted enrollment applications through completion
• Execute roster additions, updates, and terminations as directed by Senior IC
• Correct roster discrepancies
• Maintain payer contact lists and portal access
• Track enrollment statuses and update Salesforce accordingly
• Manage CAQH and PECOS profile maintenance
• Follow up on payer issue tickets and cases

Provider Experience

• Handle provider onboarding communications, status update requests, and documentation guidance
• Manage provider issue intake and routing
• Follow up with providers on missing items

Revenue Protection Support

• Support enrollment-related claim denial triage
• Assist with provider billing activation coordination
• Help resolve roster-related billing issues

Compliance Execution

• Gather audit evidence as directed by Senior IC
• Prepare delegated credentialing files
• Perform credentialing file QA
• Collect and verify provider malpractice policies and insurance documents
• Track insurance expiration dates and follow up on renewals

Systems & Data

• Ensure provider demographic data is current across credentialing systems, CAQH, and payer records
• Maintain credentialing platform records and internal trackers
• Maintain payer portal accounts

Requirements:

• 3+ years of experience in credentialing and/or enrollment operations
• Working knowledge of NCQA standards, CAQH, and payer enrollment processes
• Experience with both commercial and government payer enrollment preferred
• Proficiency with payer portals (CAQH, PECOS, Availity, payer-specific)
• Strong attention to detail and documentation habits
• Ability to manage multiple priorities and meet deadlines consistently

Benefits:

• A competitive salary
• Fully paid for comprehensive health care (medical, dental, vision)
• Pet Insurance 
• Life Insurance & Short / Long Term Disability 
• 401k Plan 
• Unlimited PTO and sick leave
• Parental Leave 
• Work remotely and whatever schedule works best for you
• Additional memberships and perks

Work Environment & Culture

At Brightside Health, you’ll join a fully remote, mission-driven team that values flexibility and impact. You’ll collaborate with professionals across engineering, product, and clinical teams, all dedicated to transforming mental healthcare. Our culture fosters continuous learning, empathy, and cross-functional collaboration.

We celebrate diversity and are committed to equal employment opportunities based on merit, competence, and performance. Research shows that underrepresented groups often apply only if they meet 100% of the listed criteria—we encourage women, people of color, and LGBTQ+ job seekers to apply even if they don’t check every box.

Compensation & Hiring Commitment

Final offers are determined by multiple factors, including location, experience, and expertise. If you have questions about compensation bands, please ask your recruiter.

At Brightside, we recognize that building life-changing technology for mental health is both a responsibility and a privilege. We set high standards while ensuring every team member is valued, trusted, and empowered in an environment driven by inclusion and impact.