Forge Health · 8 hours ago
Senior Credentialing & Enrollment Specialist
East Coast, USA
Full-time
Onsite
Senior Level
5+ years expForge Health is a mission-driven outpatient mental health and substance use provider dedicated to providing high-quality care. The Senior Credentialing & Enrollment Specialist will manage the enrollment and credentialing process for all providers and facilities with government and commercial payors, ensuring compliance and supporting billing operations.
ConsultingHealth CareMental HealthRehabilitation
Responsibilities
Prepare, submit, and track initial and recredentialing applications with Medicaid, Medicare, and commercial insurance payors
Collect and verify providers’ qualifications and documentation to ensure standards are met
Maintain accurate provider records including NPI, CAQH, licensure, DEA, and malpractice documentation
Monitor enrollment timelines and proactively follow up with payors to ensure timely approval
Collaborate with internal teams (billing, operations, compliance, HR) to ensure provider setup aligns with system and contractual requirements
Update EMR and RCM systems with credentialing and enrollment data to support billing readiness
Communicate enrollment status updates to leadership, regional teams, and providers
Research and resolve payor issues, enrollment denials, or discrepancies in provider information
Maintain compliance with federal, state, and payor-specific credentialing regulations
Support audits by providing documentation related to provider enrollment and credentialing records
Qualification
Required
Minimum 5-7 years of experience in healthcare payor enrollment and credentialing
Deep understanding of commercial and government payor enrollment processes and requirements
Proficiency in EMR/Practice Management systems and CAQH ProView
Excellent attention to detail, organizational skills, and follow-through
Strong written and verbal communication with ability to interact professionally with providers and insurance representatives
Preferred
Certified Provider Credentialing Specialist (CPCS), or similar certification, is a plus
Benefits
Comprehensive paid time off package
Annual time off to volunteer
Parental leave
Annual continuing education allocations
Competitive medical, dental, and vision package
Annual subscription to a leading meditation app
An environment that fosters professional development including financing for advanced licensure and certifications
Internal supervision opportunities
Company
Forge Health
Forge Health is a technology provider for substance use, mental health, or trauma patients.
201-500 employees
Funding
Current Stage
Growth StageTotal Funding
$11MKey Investors
MFO VenturesHC9 VenturesMontage Ventures
2024-08-22Series Unknown
2022-04-07Series Unknown· $11M
2017-01-01Seed
Leadership Team
Rondi Rabuse
Chief Executive Officer
Guy Maytal
Chief of Integrated Care
Recent News
Behavioral Health Business
2025-07-04
Behavioral Health Business
2025-06-10
Behavioral Health Business
2025-06-01
Company data provided by crunchbase