Work Arrangement: Fully Remote – with required overlap in EST working hours
Job Type: Independent Contractor, Full-time
Work Schedule: US time zone coverage required (EST daytime hours) (9:00 AM – 6:00 PM EST)
Locations:
- LATAM: Mexico City (Mexico), Bogotá (Colombia), São Paulo (Brazil), Buenos Aires (Argentina)
- Philippines: Manila, Cebu, Davao
About Pearl Talent
Pearl works with the top 1% of candidates from around the world and connects them with the best startups in the US and EU. Our clients have raised over $5B in aggregate and are backed by companies like OpenAI, a16z, and Founders Fund. They’re looking for the sharpest, hungriest candidates who they can consistently promote and work with over many years. Candidates we’ve hired have been flown out to the US and EU to work with their clients, and even promoted to roles that match folks onshore in the US.
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Why Work with Us?
At Pearl, we’re not just another recruiting firm—we connect you with exceptional opportunities to work alongside visionary US and EU founders. Our focus is on placing you in roles where you can grow, be challenged, and build long-term, meaningful careers.
Role Overview
Our client, a healthcare services organization, is seeking a Contracting and Credentialing Specialist to manage the full lifecycle of provider contracting and credentialing across its growing network. The company operates within the U.S. healthcare ecosystem, supporting providers that depend on timely insurance enrollment and compliant payer relationships.
You will own the accuracy, compliance, and timeliness of provider credentialing and payer contract maintenance—directly enabling clean claims, audit readiness, and scalable growth. This role is ideal for someone with a foundation in revenue cycle management, payer interactions, or provider data workflows. Experience in the ABA industry is a plus but not required; the client will train the right candidate on internal systems and processes.
Your Impact:
Your work will ensure the organization maintains seamless payer relationships, avoids credentialing gaps, accelerates billing readiness, and upholds compliance standards. By strengthening provider credentialing workflows and optimizing payer contracts, you will play a key role in supporting revenue generation, operational accuracy, and ongoing payer communication.
Core Responsibilities
1. Credentialing & Enrollment Management (45%)
- Maintain complete and compliant credentialing files for all providers.
- Prepare, submit, and track credentialing and re-credentialing applications across payers and networks.
- Monitor credentialing timelines, expirations, and documentation requirements to prevent any lapses.
- Resolve payer discrepancies or requests for additional documentation.
2. Contracting & Payer Relations (45%)
- Review, negotiate, and manage payer contracts to ensure favorable terms and alignment with organizational standards.
- Maintain an updated database of active contracts, renewal dates, fee schedules, and amendments.
- Research and resolve payer issues related to enrollment, contracting, or rate configuration.
- Collaborate cross-functionally with billing, operations, and RCM teams to maintain billing readiness and compliance.
3. Billing Support (10%)
- Assist with billing-related tasks including claim follow-up, enrollment-related denials, and payer verification.
- Coordinate with revenue cycle and operations teams to investigate issues linked to credentialing or contracting status.
- Support process improvements that enhance billing accuracy, provider enrollment efficiency, and payer communication.
Requirements
Must-Haves (Required)
- Minimum of 2 years of experience in contracting, credentialing, or a related revenue cycle management role.
- Familiarity with payer and provider-side operations within the U.S. healthcare system.
- Strong understanding of insurance verification, payer enrollment, and provider data management.
- Exceptional attention to detail, organization, and follow-up.
- Proficiency in Microsoft Office and credentialing/RCM software platforms.
Nice-to-Haves (Preferred)
- Experience in ABA (Applied Behavior Analysis) or behavioral health settings.
- Knowledge of CAQH, NPI registry, and major insurance portals.
- Background in both payer and provider-side RCM operations.
Tools Proficiency
Required:
- Microsoft Office Suite
- Credentialing or provider enrollment platforms
- Insurance payer portals
- Shared drives and document management systems
Preferred:
- CAQH ProView
- NPI/NPPES registry tools
- Healthcare-specific contract management systems
- RCM or enrollment workflow software
Benefits
- Competitive Salary: Based on experience and skills
- Remote Work: Fully remote—work from anywhere
- Performance Bonus: Based on data accuracy, reporting timeliness, and overall sales efficiency
- Team Incentives: Recognition for maintaining 100% CRM hygiene and on-time reporting
- Generous PTO: In accordance with company policy
- Health Coverage for PH-based talents: HMO coverage after 3 months for full-time employees
- Direct Mentorship: Guidance from international industry experts
- Learning & Development: Ongoing access to resources for professional growth
- Global Networking: Connect with professionals worldwide
Our Recruitment Process
- Application
- Screening
- Skills Assessment
- Top-grading Interview
- Client Interview
- Job Offer
- Client Onboarding
Ready to Join Us?
If this role aligns with your skills and goals, apply now to take the next step in your journey with Pearl.
