Job Overview:

Our client is looking for a State Payor Credentialing Representative to take confident, end-to-end ownership of provider enrollment for assigned high-complexity states. In this role, you will ensure that provider enrollment applications for both commercial and government payors are submitted accurately, compliantly, and within expected turnaround times. As the subject matter expert, you will leverage a deep understanding of state-specific requirements to guide submissions, resolve issues, and navigate complex regulatory environments with minimal need for escalation. Ultimately, Clients, Account Teams, and internal leadership will experience your workflow as reliable, organized, and proactive as you anticipate re-credentialing timelines and manage activity from initial application through final approval. 

Measures of Success:

• 100% verification of required data: All client-required information is confirmed prior to initiating enrollment applications.
• Submission timeliness: New provider applications are submitted within 8 working hours of receiving complete information. Applications for new payor contracts are submitted within 3–5 business days of receiving complete information.
• Proactive communication: Daily activity and follow-up reports are consistently sent to the Credentialing Representative II or State Payor Credentialing Coordinator.
• Application accuracy: Application denial rate remains below 1% across all submissions.

Schedule:

• Monday - Thursday, 8:45 AM - 5:00 PM New York Time (8:45 PM - 5:00 AM Manila Time)
• Friday, 8:45 AM - 3:45 PM New York Time (8:45 PM - 3:45 AM Manila Time)

Responsibilities:

• Lead the submission of provider enrollment applications for assigned states with complex regulations or high provider volume.
• Serve as the primary subject matter expert for credentialing and enrollment requirements in assigned state(s).
• Maintain current knowledge of both In-network and out-of-network enrollment processes.
• Partner with Account Coordinators to validate provider data and documentation prior to initiating enrollment applications.
• Establish and maintain productive working relationships with payor representatives in assigned states to support clear communication and timely issue resolution.
• Prepare and submit provider enrollment documentation through appropriate channels, including payor portals and mailed submissions.
• Track application status and perform proactive follow-ups to drive timely approvals.
• Manage re-credentialing submissions and communicate upcoming client requirements to Account Management.
• Complete quarterly and other required payor attestations to ensure ongoing compliance.
• Provide daily status reports to Credentialing Coordinator, including updates for personal workload and any Credentialing Representative I staff supporting assigned states.
• Maintain thorough documentation of all submissions, follow-ups, and payor correspondence within internal tracking systems.

Requirements:

• Exceptional attention to detail and strong organizational skills.
• Critical thinking and problem-solving abilities in complex or ambiguous situations.
• Ability to work effectively in a fast-paced, deadline-driven environment.
• Clear and professional verbal and written communication skills.
• Strong reading comprehension and ability to interpret regulatory and procedural guidance.
• Professional yet assertive communication style when working with payors to drive timely outcomes.
• Must have own computer and stable internet connection suitable for a permanent work-from-home setup.

Qualifications:

• At least 2 years in college.
• 2 years of experience in a US-based medical billing practice OR 2 years of experience in a medical practice dealing with billing (including but not limited to provider credentialing, authorizations, reimbursement, etc.), preferably in Behavioral Health to some degree.

Core Values:

Our client hires, fires, and promotes based on these core values in addition to job-specific performance:

• Respectful of our unique cultural environment
• Absolute Confidentiality
• Embracing Teamwork
• Loyal Behavior & Positive Attitude
• Accountability
• Proactiveness
• Thoroughness
• Focused on results
• Inspired to learn & grow constantly
• Devoted to providing top-tier services to clients through "Unique Service Oriented Philosophies"

Independent Contractor Perks:

• Permanent work from home
• Immediate hiring
• Steady freelance job
• Profit sharing incentive
• Paid time off
• Holiday pay
• Annual Performance and Raise Evaluation
• Quarterly Perfect Attendance Incentive
• HMO
• BruntWork Loan Assistance

Note:

Please click the "Apply" button to complete your application, including the assessment questions, technical check, and voice recording. Your hourly pay rate will be established based on your performance in the application process; submissions with all requirements fulfilled will receive priority review.

Please note that since this is a permanent work-from-home position and an “Independent Contractor” arrangement, candidates will handle their own benefits and taxes.