Credentialing Specialist

DescriptionThe Credentialing Specialist plays a critical role in supporting Turnwell’s mission by ensuring that all providers are credentialed, re-credentialed, and enrolled with payors efficiently and accurately. This role works closely with internal teams and external partners to maintain compliance with regulatory and accreditation standards and supports a high-performing provider onboarding experience. ResponsibilitiesCoordinate and manage end-to-end initial credentialing, re-credentialing, and payor enrollment processes for new and existing providers across multiple states. Prepare and submit credentialing and enrollment applications to commercial insurance payors, Medicare, and Medicaid. Maintain accurate and up-to-date provider data in credentialing databases (e. g. , CAQH, NPPES, PECOS).

Track and follow up on application statuses; proactively resolve discrepancies or delays with payors. Ensure compliance (as appropriate) with NCQA, Joint Commission, CMS, and state licensing board standards. Collaborate with HR, recruitment, and operations to ensure smooth provider onboarding and readiness to bill. Maintain digital credentialing files and documentation, ensuring data integrity across systems. Respond to payor audits, verifications, and recredentialing notices in a timely manner. Identify opportunities for process improvement and assist in building scalable credentialing workflows. Assist with special projects as needed, including support for acquisitions, new markets, and delegated credentialing contracts. RequirementsRequired:

2+ years of experience in provider credentialing and/or payor enrollment, preferably in behavioral health or multi-state environmentsWorking knowledge of Medicare, Medicaid, and commercial insurance payor processesFamiliarity with systems such as CAQH, PECOS, NPPES, and payor-specific portalsStrong organizational skills with exceptional attention to detail and accuracyAbility to manage multiple priorities and meet deadlines independentlyExcellent written and verbal communication skillsHigh level of professionalism and discretion with confidential informationPreferredExperience credentialing psychiatrists, psychologists, therapists, and NPsKnowledge of NCQA, URAC, or The Joint Commission standardsExperience in a growth-stage healthcare organization or MSOAssociate’s or bachelor’s degree in health administration or related field