Licensing & Credentialing Specialist (Remote, W2)

About CareTalk Health

CareTalk Health is a virtual medical practice that specializes in Clinical Process Outsourcing (CPO). We partner with healthcare organizations to build and manage patient and member populations.

About the Role

The Licensing & Credentialing Specialist is responsible for managing end-to-end provider credentialing, licensing, and payer enrollment processes across a nationwide, 50-state virtual care model. This role ensures all providers and nursing staff meet regulatory, accreditation, and payer requirements while maintaining accurate, compliant records across multiple systems.

This individual will also serve as a key resource for state-specific regulatory requirements, including nurse licensure tracking and Nurse Practitioner (NP) collaborative agreement requirements, ensuring CareTalk Health remains compliant across all jurisdictions.

What You’ll Do

Key Responsibilities

• Manage full-cycle provider credentialing and recredentialing processes in compliance with CMS, NCQA, and state regulatory requirements
• Oversee medical payer enrollment activities, ensuring timely and accurate submission of applications to commercial payers and government entities (e.g., Medicare)
• Complete and manage PECOS and CMS 855i enrollments and updates
• Partner with providers to maintain and update CAQH profiles to ensure accuracy and attestation compliance
• Maintain and track provider records in credentialing databases, ensuring data integrity, accuracy, and confidentiality

Licensure & Compliance Oversight

• Track and manage active licenses and expiration dates via Modio for: 
  • Physicians and Advanced Practice Providers 
  • Registered Nurses (RNs) 
  • Licensed Vocational Nurses (LVNs) 
  • Licensed Practical Nurses (LPNs) 
  • Proactively monitor expirations and coordinate renewals via Modio to ensure uninterrupted compliance and ability to practice

Multi-State Regulatory Expertise

• Maintain working knowledge of all 50-state licensure and practice requirements impacting telehealth delivery
• Research and interpret state-specific regulations, including: 
  • Nurse Practitioner collaborative/supervisory agreement requirements 
  • Scope of practice variations by state 
• Establish and maintain processes to ensure compliance with varying state laws and regulatory updates

Credentialing Operations

• Coordinate and manage collaborative agreements in accordance with state-specific requirements
• Monitor credentialing status and proactively resolve issues or delays with payers and regulatory agencies
• Conduct thorough review of credentialing applications in alignment with NCQA and accreditation standards
• Maintain provider data across platforms including CAQH, NPPES, PECOS, and payer portals

Data Integrity & Compliance

• Maintain comprehensive databases of provider information, ensuring accuracy and confidentiality
• Handle sensitive information with strict adherence to HIPAA and healthcare privacy standards
• Collaborate cross-functionally with recruiting, operations, and compliance teams to ensure timely onboarding

What We’re Looking For

Required

• 3+ years of experience in healthcare credentialing, licensing, and payer enrollment
• Strong knowledge of CMS regulations, Medicare enrollment processes, and multi-state licensing requirements
• Hands-on experience with CAQH, PECOS, NPPES, and payer portals 
• Experience managing 855i applications and Medicare provider enrollment workflows 
• Demonstrated experience tracking multi-state licensure and expirations for providers and nursing staff (RNs, LVNs, LPNs)
• Experience researching and applying state-specific regulatory requirements, including NP collaborative agreements
• Knowledge of credentialing standards including NCQA 
• Strong database management experience within credentialing systems 
• Exceptional organizational skills with strong attention to detail 

• Certification from National Association Medical Staff Services (NAMSS): 
• Certified Provider Credentialing Specialist (CPCS) 
• Certified Professional Medical Services Management (CPMSM) 

• High attention to detail and regulatory accuracy 
• Strong organizational and workflow management skills 
• Ability to operate independently in a remote environment 
• Analytical mindset with ability to research and interpret regulations 
• Strong communication and cross-functional collaboration 

Technical Requirements:

• Computer:
  • Windows or Apple (macOS) Computer ONLY (NO Chromebooks, Linux Machines, or Smartphones)
  • Must have at least Windows 10 or macOS 14 Sonoma.
• Hardware: 
  • Processor: Intel Core i5 or AMD Equivalent (Windows); Apple Silicon (Macs)
  • RAM: 16 GB
• Headphones: Wired headphones required for optimal audio quality. (NO built-in mics)
• Internet Speed: Meet minimum internet speed requirements (100 MBPS download speed and 50 MBPS upload speed). Must have an ethernet cable connecting computer directly into router.
• Browser and System: Use Google Chrome with Amazon Workspaces (regardless of computer type). 
• Webcam: A webcam is required for video calls. Most laptops have a built-in webcam, which is acceptable. If your computer does not have a webcam, you will need to use an external webcam.
• Recommended Equipment: A second monitor is highly suggested for laptop users; dual monitors for PC users. 

Why CareTalk Health

• CareTalk Health is a fast-growing telehealth organization that delivers high-quality virtual care at scale. This role offers the opportunity to shape contractor operations, influence performance outcomes, and support innovative care models across a nationwide clinical workforce.

CareTalk Health is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran, or disability status.

California applicants: Please review our California Applicant Privacy Notice at Collection before applying. The notice explains the categories of personal information we collect, how we use and retain it, whether we sell or share it, and your privacy rights under California law: https://caretalkhealth.com/california-privacy-notice