Managed Care Provider Credentialing Specialist II - Experience Required

Job Description:

Job Title: Managed Care Credentialing Representative IILocation: Remote / Work from HomeDepartment: Managed CareEmployment Type: Full-TimePay Range: $17.93-$26.01 per hour, based on relevant experience and work location

Qualification Overview:Required: Previous healthcare provider credentialing experienceRequired: Professional experience in an administrative, office, data-management, insurance, billing, claims, healthcare, financial, or similarly detail-focused business environment

Strongly Preferred: Healthcare revenue cycle experience, including patient billing, insurance claims, collections, or reimbursement

Preferred: Provider enrollment, payer enrollment, managed care, privileging, or recredentialing experience

Join a Recognized Top Workplace

Centerstone is a nationally recognized behavioral health organization and has been named a Top Workplace in consecutive years, including 2025 and 2026. Top Workplaces recognition is based entirely on confidential employee feedback and reflects the workplace culture, engagement, and employee experience created by the people who work here.

Learn more about working at Centerstone

Job Summary:

Bring your healthcare credentialing experience, attention to detail, and ability to manage complex information to a remote role that helps qualified providers deliver care. As a Managed Care Credentialing Representative II, you’ll guide providers through initial credentialing and recredentialing, verify professional qualifications, maintain accurate records, and help ensure compliance with payer, regulatory, and organizational requirements.

This position is designed for candidates with previous healthcare provider credentialing experience and professional experience managing detailed records, applications, documentation, and deadlines. You’ll collaborate with providers, internal teams, and external organizations while supporting accurate, efficient, and compliant credentialing processes.

This position offers…

• Competitive Pay – $17.93-$26.01 per hour, based on relevant experience and work location
• Employee Assistance Program – 24/7 counseling services, legal assistance, & financial consultation for you and your household at no cost
• Mileage Reimbursement – Company paid for work functions requiring travel
• Employee Discounts – Hotels, Theme Parks & Attractions, College Tuition
• Workplace Culture – An environment cultivating employee wellbeing, valuing each individual's humanity, and actively promoting a healthy, joyful workforce
• Remote Work Opportunity – Work from home while supporting providers and teams across the organization
• Additional Perks & Benefits – Scroll down to bottom of this post to learn more

Key Responsibilities:

• Guide providers through initial credentialing, recredentialing, enrollment, and application processes while providing clear and responsive support
• Complete credentialing and recredentialing applications accurately and within required regulatory, contractual, and organizational timelines
• Verify provider education, training, licensure, certifications, professional history, privileges, and other required credentials
• Maintain accurate provider profiles, credentialing databases, applications, verification records, and supporting documentation
• Monitor application progress, expiring credentials, outstanding documentation, and recredentialing deadlines to prevent delays
• Investigate discrepancies, adverse findings, and incomplete information and communicate concerns to supervisors or leadership when appropriate
• Coordinate with providers and internal stakeholders to obtain documentation, update license or privilege information, and resolve credentialing issues
• Support external privileging, managed care requirements, payer requests, audits, and other compliance-related activities
• Research credentialing standards, payer requirements, and industry policies and translate findings into clear action steps
• Protect provider data and maintain confidentiality, accuracy, compliance, and complete audit-ready records

Education, Experience, and/or Credential Qualifications:

Required

• High school diploma, GED, or equivalent
• Previous professional experience in healthcare provider credentialing
• Professional experience in an administrative, office, data-management, insurance, billing, claims, healthcare, financial, or similarly detail-focused business environment
• Experience processing detailed applications, verifying documentation, maintaining accurate records, and meeting established deadlines
• Professional proficiency with Microsoft Office applications, including Microsoft Excel
• Ability to work independently in a remote environment with strong organization, time management, and follow-through

Preferred

• Healthcare revenue cycle experience, including patient billing, insurance claims, collections, payment processing, reimbursement, or related payer functions
• Experience with provider enrollment, payer enrollment, managed care, privileging, delegated credentialing, or revalidation
• Experience communicating with commercial insurance carriers, Medicaid, Medicare, managed care organizations, healthcare providers, or external privileging organizations
• Knowledge of provider credentialing standards, payer requirements, regulatory compliance, and primary-source verification
• Advanced Microsoft Excel experience, including sorting, filtering, formulas, data validation, and tracking large amounts of information
• Experience working remotely in credentialing, healthcare administration, provider enrollment, payer operations, or revenue cycle

Additional Qualifications:

• Exceptional organization, accuracy, follow-through, and attention to detail
• Strong written and verbal communication and customer-service skills
• Ability to research credentialing and payer policies and convert complex requirements into actionable steps
• Ability to manage multiple providers, applications, deadlines, projects, and stakeholder requests simultaneously
• Strong analytical, auditing, problem-solving, and process-improvement skills
• Ability to identify and appropriately escalate adverse, questionable, or incomplete credentialing information
• Ability to protect confidential provider, organizational, and healthcare information
• Reliable professional workspace and ability to collaborate effectively in a remote environment
• Current driver’s license, acceptable driving record, and current auto insurance

Physical Requirements:

• Perform primarily sedentary work in a remote environment involving extended periods of sitting and computer use
• Frequently use hands, fingers, and arms for typing, data entry, application processing, and electronic communication
• Occasionally stand, walk, or move materials weighing up to 10 pounds
• Perform the essential functions of the position with or without reasonable accommodation

Help Qualified Providers Deliver Care

Accurate healthcare credentialing protects patients, supports regulatory compliance, and helps qualified providers begin serving communities without unnecessary delays. If you have the required healthcare credentialing experience and the organization, judgment, and attention to detail needed to manage complex provider information, we encourage you to apply and grow with our remote Managed Care team.

Position Perks & Benefits:

Paid time off: full-time employees receive an attractive time off package to balance your work and personal life

Employee benefits package: full-time employees receive health, dental, vision, retirement, life, & more

Top-notch training: initial, ongoing, comprehensive, and supportive

Career mobility: advancement opportunities/promoting from within

Welcoming, warm, supportive: a work culture & environment that promotes your well-being, values you as human being, and encourages your health and happiness

Brightli is on a Mission:

A mission to improve client care, reduce the financial burden of community mental health centers by sharing resources, a mission to have a larger voice in advocacy to increase access to mental health and substance user care in our communities, and a mission to evolve the behavioral health industry to better meet the needs of our clients.

As a behavioral and community mental health provider, we prioritize fostering a culture of belonging and connection within our workforce. We encourage applications from individuals with varied backgrounds and experiences, as we believe that a rich tapestry of perspectives strengthens our mission. If you are passionate about empowering local communities and creating an environment where everyone feels valued and supported, we invite you to join our mission-driven organization dedicated to cultivating an authentic workplace.

We are an Equal Employment Opportunity Employer.

Brightli is a Smoke and Tobacco Free Workplace.