Credentialing and Licensing Specialist

About Boulder

Boulder Care is an award-winning digital clinic for addiction medicine, recognized for both innovation and high quality of patient care. Founded in 2017 by CEO Stephanie Strong, our mission is to improve the lives of people with substance use disorders through compassionate, evidence-based care.

We provide Boulder patients with a fully virtual, multidisciplinary care team—including medical providers, behavioral health clinicians, and peer recovery specialists—who deliver personalized treatment, including medication-assisted treatment (MAT) and ongoing support. Our approach is grounded in clinical excellence, patient-centered care, and a commitment to reducing barriers to recovery. Boulder partners with leading health plans, employers, and community organizations to ensure that our services are accessible and covered for the people who need them most.

Named by Fortune as one of the Best Workplaces in Healthcare, Boulder fosters a culture of kindness, respect, and meaningful work that delivers outstanding patient outcomes and moves the addiction medicine industry forward.

About this role

Boulder Care is seeking a Credentialing & Licensing Specialist who will be responsible for coordination, submission, and oversight of several aspects of Boulder’s provider licensing, credentialing and payer contracting processes. You will ensure our medical providers possess the necessary licenses, credentials and contracts to perform their work in compliance with all federal, state, and payor-specific regulations.

Success in this role

Provider Credentialing - 50%

• Completing and submitting credentialing and recredentialing applications with all payers accurately and in a timely manner; Ensuring submission deadlines are met and submission documentation is maintained appropriately
• This role has both daily and weekly task deadlines, that are set in collaboration with the Credentialing and Licensing Supervisor
• Building and maintaining strong relationships with the payer communities, including the government payer community (Medicaid, Medicare, VA, etc)
• Tracking progress of outstanding applications to completion and reporting progress to the Credentialing and Licensing Supervisor as requested
• Resolving credentialing issues through collaboration with management, senior team members, payers, and others as identified
• Maintaining provider records as they pertain to licensing and credentialing through the approved platform

Provider Licensing/Onboarding - 40%

• Assisting with new provider onboarding
• Assisting with obtaining needed documentation from providers, such as copies of state licenses, IRS documents, NPI Notification forms, DEA numbers, board certifications, malpractice certificate of insurance, etc
• Applying for provider state licenses, DEA certifications and state controlled substance certifications; re-certify as needed 

Administrative - 10%

• Other duties as assigned

Requirements for the role 

• 2+ years of experience in healthcare provider credentialing, licensing, contracting, billing, or a similar medical staff role
• Experience with CAQH, PECOS, Medicaid, and/or Medicare
• Demonstrated understanding of how provider contracting and credentialing impacts billing, contracts, and revenue management/collections
• Understands medical terminology, procedure codes and diagnosis codes as it applies to payor contracts
• Substantial organizational skills, including multitasking and time-management
• Reliable customer service, follow-up, and communication skills
• Ability to work effectively both independently and as part of a team
• Team-focused; effective collaboration. Serves both the team and the customer at a consistently high level
• Strong critical thinking, problem solving abilities, and attention to detail
• Demonstrates high ethical standards of behavior
• Maintains composure under pressure
• Regularly demonstrates Boulder’s core values

Nice to have but not required

• Provider licensing - state and/or DEA
• Multi-state credentialing experience
• Experience working with Modio

Work environment

• This is a fully remote role but we are currently only hiring candidates located in the following states: AZ, CO, FL, GA, ID, IL, KY, MA, NC, NJ, NY, OH, OR, PA, SC, TN, TX, UT, WA, or WV. Applicants must reside and work in one of those states to be considered
• Boulder Care employees are free to use our river-fro