Credentialing Specialist

Overview

Join our dynamic healthcare team as a Credentialing Specialist, where your expertise will ensure seamless provider credentialing and compliance processes. In this vital role, you will manage the verification and maintenance of healthcare provider credentials, ensuring adherence to industry standards, regulatory requirements, and payer policies. Your proactive approach will support our mission to deliver high-quality, compliant healthcare services while maintaining confidentiality and accuracy in all credentialing activities. This position offers an exciting opportunity to contribute to a fast-paced environment dedicated to excellence in healthcare administration.

Duties

• Review and verify medical credentialing applications, ensuring completeness and accuracy in accordance with healthcare accreditation standards such as NCQA and JCAHO.
• Manage medical payer enrollment processes, including submission of credentialing applications to insurance payers and government agencies like CMS (Centers for Medicare and Medicaid Services).
• Maintain up-to-date knowledge of state healthcare regulations, CMS policies, and health insurance requirements to ensure compliance across all credentialing activities.
• Utilize healthcare software applications and databases to track credentialing statuses, document updates, and manage provider records securely.
• Coordinate with healthcare providers, administrative staff, and payers to resolve credentialing issues promptly and efficiently.
• Conduct thorough reviews of medical credentialing applications, verifying licensure, certifications, malpractice insurance, and other credentials against regulatory standards.
• Ensure all credentialing documentation complies with healthcare compliance guidelines, including JCAHO accreditation standards and NCQA accreditation requirements.

Skills

• Strong knowledge of managed care processes and health insurance policies.
• Proven experience with medical credentialing software systems and database management tools.
• Excellent understanding of medical terminology, healthcare regulations, and compliance standards such as CMS regulations and state healthcare laws.
• Demonstrated ability to handle confidential information with discretion and professionalism.
• Effective contract management skills within a healthcare setting.
• Proficiency in Microsoft Office Suite for documentation, reporting, and communication purposes.
• Prior experience in medical office administration or healthcare compliance roles is highly desirable.

This role is ideal for motivated professionals eager to make a meaningful impact on healthcare quality through meticulous credentialing practices. We are committed to fostering an inclusive environment where your expertise helps shape compliant, efficient healthcare delivery every day!

Pay: $24.76 - $29.82 per hour

Expected hours: 36.0 per week

Work Location: Remote