Credentialing and Health Insurance Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee all facets of the provider licensing and credentialing process, including participation in health plan networks across various states.

• Facilitate the onboarding of new providers through the IMLC, as well as licensure, Medicare, Medicaid, and DEA processes.

• Maintain and verify provider data on platforms such as CAQH, NPPES, PECOS, Availity, and other external sites.

• Manage provider renewals that encompass IMLC, licensure, and Nurse Compact requirements.

• Handle health plan applications, follow up on submissions, manage contracting, and credentialing for fee-for-service agreements.

• Ensure compliance with health plan credentialing standards and specific training prerequisites.

• Administer databases, including effective-date entries and password management.

• Assist billing partners with effective dates, passwords, and health plan-related concerns.

• Formulate policies and procedures for physician credentialing and contracting.

• Coordinate with Operations to facilitate provider scheduling.

• Enhance revenue cycles, ensure adherence to state and federal regulations, and contribute to the financial well-being of the organization.

⛳️ Requirements

• Bachelor’s degree in healthcare administration, business, or a related field, or equivalent professional experience.

• At least 2 years of experience in provider onboarding.

• Expertise in health plan networks.

• In-depth understanding of licensing, credentialing, Medicare, and Medicaid.

• Knowledge of HIPAA regulations and privacy standards.

• Extensive knowledge of provider licensure and credentialing across multiple states and various provider types.

• Familiarity with external regulatory systems, state and federal requirements, and compliance standards.

• High degree of accuracy when managing provider information, licensure data, and records.

• Capability to analyze complex licensure issues, identify inconsistencies, and devise effective solutions.

• Proficient in clearly communicating intricate licensure and credentialing matters to Operations.

• Strong ability to utilize and adapt to billing software, electronic health record systems, and data analysis tools.

🏝️ Benefits

• An opportunity to join a dynamic, mission-driven organization.

• Competitive base salary.

• Market-competitive healthcare benefits, including medical, dental, vision, life, and disability coverage.

• A chance to collaborate with talented and professional colleagues while having the opportunity for growth.