Credentialing Lead - US Medical (Remote)

About Carepatron

Carepatron is one of the fastest-growing AI-native healthcare platforms in the world. We're building the operating system healthcare practitioners actually want to use: simple, powerful, and designed to get them paid faster with fewer headaches.

Thousands of US healthcare organizations already run their practices on Carepatron. Our RCM service is the next layer on top of that platform. We take on the credentialing, billing, and collections work so practitioners can focus on care, and we're automating more of it with AI every month.

The Opportunity

We're hiring a Credentialing Lead to build and run the credentialing and payer enrollment function inside Carepatron's RCM team.

Credentialing is where the clock starts for every new RCM client. Many of the practices joining our billing service are new to insurance billing. They can't submit a single claim until their providers are enrolled with Medicare and their state Medicaid program, and in-network with the Medicaid managed care plans and commercial payers their patients carry. The faster and cleaner we get that done, the faster they get paid, and the faster Carepatron grows.

You'll own that outcome end to end: the applications, the follow-ups, the payer relationships, the tracking, and the team. This is a player-coach seat. You'll work the hard files yourself, especially in the early months, while hiring and training the specialists who'll work alongside you as volume grows.

You'll report to our Head of Customer Success and work closely with our RCM, onboarding, and product teams. The role is based in the Philippines and works US business hours.

What You'll Own

Credentialing and Enrollment, End to End

• Initial credentialing and payer enrollment for every new RCM client: Medicare (PECOS), state Medicaid programs and their managed care plans (MCOs), and commercial payers across multiple states
• Medicare enrollment that's current. MFTs and mental health counselors have been eligible since January 2024, and you catch providers with an active opt-out before they bill
• CAQH ProView profiles, NPI setup (Type 1 and Type 2), taxonomy codes, and group-to-provider linking so claims pay correctly from the first submission
• EFT, ERA, and clearinghouse enrollment so payments and remits land where they should
• Payer contracting execution: participation agreements, adding providers to existing group contracts, and tracking contract effective dates and fee schedules
• Re-credentialing, Medicare and Medicaid revalidation, CAQH re-attestation every 120 days, and expirables tracking (licenses, malpractice COI, DEA where applicable) so no provider falls out of network
• A follow-up cadence and escalation path for when payers stall, lose paperwork, or sit on an application past their stated turnaround, including closed-panel appeals and single case agreements
• The numbers you live by: time to in-network, first-pass application acceptance, and credentialing-related denials
• HIPAA compliance, monthly OIG and SAM exclusion checks, and payer-specific requirements across every file you touch

Team and Operations

• Hire, train, and lead a small team of credentialing specialists as client volume grows, with clear SLAs and accountability per file
• Build the credentialing playbook: checklists by payer and state, document collection templates, and a follow-up rhythm that never lets a file go quiet
• Keep a live credentialing tracker that shows every provider's status, aging, blockers, and expected effective date, visible to the client and to our team
• Partner with onboarding and customer success so clients know exactly what we need from them and when they can start billing

Product Partnership

• Work with product and engineering to turn your workflows into automation: document collection, application prefill, status tracking, and payer follow-up
• Tell us which credentialing steps are ready to hand to software and which still need a human. We're automating RCM aggressively and credentialing is next
• Shape how credentialing shows up inside the Carepatron platform so it becomes something practitioners barely have to think about

What You Bring

• 5+ years in US provider credentialing and payer enrollment, with 2+ years leading a team or owning the function outright
• Hands-on with CAQH ProView, NPPES, PECOS, state Medicaid portals, and commercial payer enrollment through Availity and payer-specific portals
• Multi-state experience. You know Medicaid in Texas works nothing like Medicaid in California, and you've handled both
• You know what payers verify and why applications bounce: work history gaps, malpractice history, and name and address mismatches across NPPES, CAQH, and the W-9
• Fluent in the plumbing: EFT and ERA enrollment, taxonomy codes, group versus individual enrollment, and how an effective date flows through to a clean claim
• Experience credentialing behavioral health, ABA, therapy, and allied health providers (LCSWs, LPCs, LMFTs, psychologists, BCBAs, SLPs, OTs, PTs), including pre-licensed clinicians billing under supervision, where payer rules are at their most inconsistent
• Analytically self-sufficient. You track your own pipeline, spot aging files before they become problems, and report on time to in-network without being asked
• A clear communicator in English, written and spoken. Comfortable on the phone with a payer rep and on a call with a client explaining why their enrollment is taking 90 to 180 days
• Based in the Philippines and able to work a fixed US business hours schedule consistently

What Makes You Stand Out

• You've built a credentialing function or playbook from scratch, or taken over a messy one and made it run
• Experience inside a US RCM company, healthcare BPO, or credentialing vendor serving many practices at once, not just one health system
• Experience with telehealth and multi-state providers, and you understand what interstate compacts like PSYPACT and the Counseling Compact mean for licensure and enrollment
• Familiarity with credentialing software (Medallion, Verifiable, Modio, symplr CredentialStream) and an opinion on what they get wrong
• A track record of measurably cutting time to in-network or credentialing-related denials, with numbers to back it up
• CPCS or CPMSM certification through NAMSS is a plus

Why Carepatron

• A mission-driven team improving life for healthcare professionals worldwide
• Fully remote, with a fixed US-hours schedule and a team that trusts you to run your own day
• A seat at the start of something. You'll build the credentialing function, not inherit it, and the role is designed to grow with you
• Competitive compensation with performance incentives
• Work alongside world-class designers, engineers, and operators shaping the future of healthcare software