Credentialing Specialist
We are seeking a Credentialing Specialist with 3 to 5 years of experience to support credentialing and recredentialing operations for a growing health plan. This role will focus on maintaining provider data accuracy, supporting compliance with NCQA standards, understanding state and federal network participation regulations, delegated credentialing, and ensuring timely, audit-ready credentialing processes.
Company Overview
Antidote Health is a tech-driven health insurance company on a mission to make healthcare easy, accessible, and more affordable. We’re rethinking how healthcare works—using technology to remove the friction, complexity, and delays that define the traditional system. Instead of navigating paperwork, long waits, and disconnected experiences, we’re building a simpler, more connected way for people to get care.
Our platform combines health coverage, virtual care, and a modern member experience into one seamless system designed to help people actually use their benefits.
We offer Affordable Care Act (ACA) health plans in Arizona and Ohio, and we’re growing quickly. We’re building a company focused on solving real problems—with real impact on people’s lives.
Position Overview
We are seeking a Credentialing Specialist with 3 to 5 years of experience to support credentialing and recredentialing operations for a growing health plan. This role will focus on maintaining provider data accuracy, supporting compliance with NCQA standards, understanding state and federal network participation regulations, delegated credentialing, and ensuring timely, audit-ready credentialing processes. Candidates with experience in NCQA-accredited or certified environments are strongly preferred.
Key Responsibilities
- Manage credentialing and recredentialing cases in Medallion credentialing platform
- Review provider files for completeness and identify non-clean cases
- Conduct provider outreach to obtain missing or insufficient information
- Support roster submissions and validate data accuracy
- Assist with credentialing mailbox
- Assist with credentialing case coordination
- Prepare documentation for credentialing committee
- Support internal and external audits, including NCQA and delegated entities
- Track recredentialing timelines and ensure timely completion
- Assist with delegation support, monitoring, and compliance tracking including pre-delegation assessments, annual assessments, and reports
- Maintain accurate, complete, and audit-ready credentialing records
Qualifications
Required:
- 3 to 5 years of credentialing experience in a healthcare or health plan environment
- Experience in NCQA-accredited or certified credentialing programs strongly preferred
- Working knowledge of NCQA credentialing standards, delegation, and state and federal regulations
- Experience with Medallion preferred
- Strong attention to detail and ability to identify and resolve data issues
- Ability to summarize complex cases and communicate clearly
- Strong organizational and time management skills
Preferred:
- Health plan credentialing experience preferred
- NCQA-focused experience preferred over URAC or hospital or JCAHO-based experience
- Experience supporting audits, delegation oversight, and high-volume credentialing operations
Compensation and Benefits:
- Salary range: $27-$33/hour
- This role is a 3-6 month initial contract with the potential to convert to full time
- This is a fully remote opportunity
Equal Opportunity Statement
Antidote Health is an equal opportunity employer and makes employment decisions without regard to race, color, religion, sex, national origin, age, disability, veteran status, or any other protected status under applicable law.
