Job Overview
We are seeking a highly motivated and detail-oriented Credentialing Specialist to join our healthcare team. In this vital role, you will oversee the credentialing and re-credentialing processes for healthcare providers, ensuring compliance with all relevant regulations and standards. Your expertise will help facilitate smooth provider enrollment, maintain accurate credentialing records, and support the organization’s commitment to delivering high-quality, compliant healthcare services. This position offers an exciting opportunity to contribute to a dynamic healthcare environment where precision, efficiency, and regulatory knowledge are essential for success.
Responsibilities
- Review and verify medical credentialing applications, ensuring completeness and accuracy in accordance with healthcare industry standards.
- Manage provider enrollment processes with medical payers, including insurance companies and government programs such as CMS (Centers for Medicare and Medicaid Services).
- Maintain up-to-date knowledge of state healthcare regulations, accreditation standards (such as JCAHO and NCQA), and health insurance policies to ensure compliance.
- Utilize healthcare software applications and medical credentialing software to track application statuses, update databases, and generate reports.
- Coordinate with providers to gather necessary documentation, including licenses, certifications, malpractice insurance, and other credentialing requirements.
- Conduct thorough reviews of credentialing applications to identify discrepancies or missing information before submission.
- Ensure all credentialing activities adhere to healthcare compliance guidelines, confidentiality protocols, and regulatory requirements.
Skills
- Strong understanding of managed care processes and health regulation policies.
- Proven administrative experience within healthcare settings, including medical office operations.
- Proficiency in Microsoft Office Suite (Word, Excel, Outlook) and healthcare software applications.
- Experience with medical credentialing software platforms and database management systems (e.g. MCC, Availity).
- Knowledge of medical payer enrollment procedures and CMS regulatory compliance standards.
- Familiarity with medical terminology, healthcare accreditation standards (JCAHO, NCQA), and state healthcare regulations.
- Excellent organizational skills with attention to detail for reviewing credentialing applications thoroughly.
- Ability to handle confidential information discreetly while maintaining data integrity across multiple systems.
- Contract management experience in healthcare environments is a plus.
- Knowledge in credentialing processes in other states (e.g. CA, IL, ID, OH, FL, TX, CO) a plus.
Join us in this rewarding role where your expertise will directly impact the quality of care delivered by our organization! We value your dedication to maintaining the highest standards of healthcare compliance while supporting provider credentials that enable seamless patient access to services.
Pay: $18.00 - $25.00 per hour
Experience:
- Credentialing: 1 year (Preferred)
Work Location: Remote
