Credentialing Maintenance Specialist

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

📋 Description

• Ensure the accuracy of provider demographic data across internal systems, credentialing platforms, and payer portals.

• Manage provider maintenance requests, which include name changes, address modifications, oversight of provider relationships, tax identification updates, and other demographic alterations.

• Track provider licenses, certifications, DEA registrations when relevant, malpractice insurance, and other essential credentials for timely renewals and adherence to compliance standards.

• Conduct periodic reviews and attestations of CAQH profiles.

• Update provider records in payer portals and directories.

• Address payer inquiries concerning provider demographics, credentialing status, and appointment availability.

• Manage updates regarding provider appointment availability and respond to network adequacy and directory validation requests.

• Keep provider records organized within MedTrainer and other organizational systems.

• Collaborate with Credentialing Enrollment Specialists on provider maintenance changes that necessitate payer notification or enrollment updates.

• Work together with Clinical Operations, Human Resources, Compliance, and Revenue Cycle teams.

• Maintain well-organized documentation of provider maintenance activities, payer confirmations, and supporting records.

• Stay informed about regulatory and payer requirements and suggest process enhancements.

• Assist in internal audits and compliance initiatives by ensuring provider records are complete, accurate, and ready for audits.

⛳️ Requirements

• Outstanding organizational abilities, keen attention to detail, and a strong commitment to accuracy.

• Capability to handle multiple provider maintenance, recredentialing, revalidation, and compliance tasks while adhering to deadlines.

• Strong skills in prioritization and time management.

• Familiarity with provider recredentialing, revalidation, licensure, certification, and payer participation criteria across various states and payer networks.

• Proficiency in Microsoft Office Suite, CAQH, payer portals, and credentialing/provider management systems.

• Experience in maintaining provider records and tracking credential expiration dates.

• Excellent verbal and written communication skills.

• Ability to interpret and apply payer, regulatory, accreditation, and organizational standards.

• Awareness of confidentiality requirements and the ability to manage sensitive information with discretion.

• Capacity to work independently while also collaborating with Credentialing, Revenue Cycle, Compliance, Human Resources, and Clinical Operations teams.

• High school diploma or equivalent is required.

• At least two (2) years of experience in provider enrollment, credentialing, healthcare administration, or a related healthcare support position.

• Preferred experience in coordinating provider recredentialing, revalidation, licensure renewals, certifications, and payer maintenance activities.

🏝️ Benefits

• Fully remote work arrangement.