Licensing & Credentialing Specialist

The Licensing & Credentialing Specialist plays a critical role in ensuring Oshi Health providers are enrolled, credentialed, and ready to deliver care. This role is primarily responsible for managing end-to-end payer enrollment activities, including provider enrollments, revalidations, demographic updates, delegated credentialing support, and ongoing maintenance across commercial, Medicare, and Medicaid health plans.

In addition to payer enrollment, this role supports provider licensing operations, including new state license applications, renewals, and ongoing compliance activities. Working closely with Practice Operations, Clinical Operations, Revenue Cycle, Recruiting, and external payer partners, the Licensing & Credentialing Specialist helps ensure providers are fully credentialed and enrolled on time, minimizing delays to patient care and reimbursement.

The ideal candidate is highly organized, detail-oriented, and thrives in a fast-paced environment. They are proactive in identifying and resolving issues, communicate effectively with internal and external stakeholders, and are passionate about creating efficient, scalable processes that support organizational growth while maintaining regulatory compliance.

What You'll Do: Key Responsibilities

• Own the end-to-end payer enrollment process for new and existing providers, including initial enrollments, revalidations, demographic updates, terminations, and maintenance across commercial, Medicare, and Medicaid health plans.
• Submit, track, and proactively follow up on payer enrollment applications to ensure timely provider participation and minimize delays to patient care and revenue.
• Serve as the primary point of contact with national and local health plans, delegated credentialing organizations, CVOs, and internal stakeholders to resolve enrollment issues, missing information requests, and payer escalations.
• Maintain accurate provider data across payer portals, CAQH, credentialing systems, and internal tracking tools, ensuring consistency across all platforms.
• Support delegated credentialing activities by maintaining provider rosters, submitting required updates, monitoring compliance requirements, and preparing documentation for internal and external audits.
• Conduct routine audits of provider enrollment and credentialing files to ensure compliance with NCQA, CMS, state, and payer-specific requirements.
• Monitor key enrollment and credentialing metrics, identify risks to provider participation, and communicate status updates and timelines to leadership and cross-functional partners.
• Collaborate closely with Licensing, Practice Operations, Revenue Cycle, Recruiting, and Clinical Operations teams to ensure providers are fully credentialed, enrolled, and ready to see patients on schedule.
• Identify opportunities to improve enrollment and credentialing workflows through process standardization, documentation, automation, and operational efficiencies.
• Support provider licensing activities as needed, including coordinating new state license applications, renewals, cross-licensure efforts, and maintaining accurate licensure records.
• Monitor provider licenses, DEA and CDS registrations, board certifications, malpractice coverage, and other required credentials to ensure continuous compliance.
• Provide exceptional support to providers throughout the enrollment, credentialing, and licensing process by communicating requirements, timelines, and next steps clearly and proactively.

What We're Looking For: Qualifications & Requirements

Required

• A Bachelor’s Degree in Healthcare administration or related field
• 3+ years of experience in provider payer enrollment and credentialing
• Experience managing provider enrollments with commercial, Medicare, and Medicaid payers.
• Experience supporting delegated credentialing activities, including provider rosters, ongoing monitoring, or audit preparation.
• Experience with multi-state or national provider organizations.
• Working knowledge of CAQH, payer portals, and provider credentialing systems.
• Understanding of NCQA, CMS, state licensing, and payer credentialing requirements.
• Strong organizational skills with the ability to manage multiple priorities and deadlines.
• Excellent attention to detail and written and verbal communication skills.
• Proficiency with Google Workspace, including Google Sheets.

Preferred

• Certified Provider Credentialing Specialist (CPCS) certification or equivalent credential preferred
• 1+ year working in Verifiable Enrollment and Licensing Manager
• Experience supporting delegated credentialing audits and corrective action plans.
• Familiarity with provider licensing and cross-state licensure.
• Experience working with credentialing vendors (CVOs).
• Experience in a virtual care or telehealth environment.
• Experience working in a fast-paced, high-growth startup environment.
• Process improvement mindset with experience documenting or streamlining workflows.