Credentialing, Licensing & Payor Enrollment Specialist
Position Title: Credentialing, Licensing & Payor Enrollment Specialist
Company: Radiology One
Location: Remote (U.S.-Based Preferred)
Reports To: Director of Credentialing Supervisor
Position Summary
We are seeking a highly organized and detail-oriented Credentialing, Licensing & Payor Enrollment Specialist to manage and support provider credentialing, state licensing, and payor enrollment activities for our growing radiology practice. This role is responsible for ensuring all radiologists maintain active credentials, licenses, hospital privileges, and payor participation to support uninterrupted clinical operations and reimbursement.
The ideal candidate has extensive experience in physician credentialing, preferably within radiology or other hospital-based specialties. Experience with multi-state medical licensing, the Interstate Medical Licensure Compact (IMLC), and credentialing platforms such as Modio Health and QGenda is highly desirable. Candidates who are comfortable leveraging AI tools such as Claude and ChatGPT to improve workflows, document preparation, research, and operational efficiency are strongly preferred.
We currently supports 70 radiologists across 13 states, providing services to approximately 30 hospitals and healthcare facilities.
Essential ResponsibilitiesCredentialing & Privileging (Required)
- Manage the full credentialing, recredentialing, and privileging lifecycle for radiologists.
- Prepare, submit, and track hospital privilege applications, medical staff appointments, and reappointments.
- Maintain provider credential files and ensure all required documentation remains current and compliant.
- Monitor and coordinate renewals for licenses, DEA registrations, board certifications, malpractice insurance, and hospital privileges.
- Serve as the primary liaison with hospitals, medical staff offices, credentialing committees, and providers.
- Ensure compliance with NCQA, CMS, Joint Commission, and hospital credentialing standards.
Licensing
- Manage physician licensing activities across multiple states.
- Coordinate initial applications, renewals, and maintenance of medical licenses.
- Assist physicians with Interstate Medical Licensure Compact (IMLC) applications and ongoing requirements.
- Monitor state-specific licensing requirements and ensure timely submission of all supporting documentation.
- Maintain accurate records and tracking systems for all provider licenses.
Payor Enrollment
- Manage provider enrollment, revalidation, and updates with Medicare, Medicaid, and commercial insurance payors.
- Complete and track enrollment applications through CAQH, PECOS, and payor portals.
- Resolve enrollment issues, denials, and delays with payor representatives.
- Ensure providers maintain active participation status to prevent interruptions in reimbursement.
- Coordinate provider roster updates and demographic changes as required.
Systems & Process Management
- Utilize Modio Health, QGenda, CAQH, PECOS, and other credentialing and enrollment platforms.
- Maintain accurate provider records and credentialing databases.
- Generate status reports and dashboards related to credentialing, licensing, and enrollment activities.
- Support audits, compliance reviews, and provider onboarding initiatives.
- Leverage AI tools such as Claude and ChatGPT to streamline administrative processes, improve documentation quality, conduct research, and increase operational efficiency.
QualificationsRequired
- 3+ years of physician credentialing experience.
- Demonstrated experience managing hospital credentialing and privileging processes.
- Experience with Medicare, Medicaid, commercial payor enrollment, CAQH, and PECOS.
- Strong understanding of credentialing regulations and compliance requirements.
- Exceptional attention to detail and organizational skills.
- Ability to manage multiple projects and deadlines simultaneously.
- Strong written and verbal communication skills.
Preferred
- Experience in radiology, teleradiology, or hospital-based physician practices.
- Experience supporting credentialing for large, multi-state physician groups.
- Knowledge of Interstate Medical Licensure Compact (IMLC) processes.
- Experience managing physician licensing across multiple states.
- Experience with Modio Health and QGenda.
- Familiarity with AI-powered productivity tools, including Claude and ChatGPT.
- CPCS, CPMSM, or similar credentialing certification.
Key Success Metrics
- Timely completion of credentialing, recredentialing, and privileging applications.
- Zero preventable lapses in provider licenses, hospital privileges, or payor enrollments.
- Efficient onboarding of new radiologists and expansion into new facilities and states.
- Accurate maintenance of provider records and credentialing databases.
Why Join Us:
- Growing physician-led radiology practice.
- Opportunity to support a large, multi-state network of radiologists and hospital partners.
- High-impact role directly supporting provider readiness, compliance, and revenue cycle performance.
- Collaborative, technology-forward environment that embraces innovation and process improvement.
Pay: $20.00 - $27.00 per hour
Work Location: Remote
