Credentialing Specialist

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

📋 Description

• Oversee the entire credentialing process for a consistent caseload of providers associated with one client.

• Review and manage credentialing applications received through CAQH ProView or client-specific onboarding forms; identify any missing or incomplete details and initiate prompt follow-up with providers or clients.

• Conduct all primary source verifications (PSVs) utilizing our client's software platform, covering areas such as licensure, education, training, board certification, DEA, NPI, NPDB, and sanctions checks.

• Analyze PSV outcomes and apply credentialing judgment to highlight discrepancies, exclusions, or matters that require escalation.

• Assemble comprehensive, audit-ready credentialing files in compliance with client standards and URAC guidelines.

• Achieve or surpass weekly productivity goals (case volume) while maintaining personal quality metrics at or above team standards.

• Keep accurate and up-to-date provider records in our clients’ or the client’s platform throughout the credentialing process.

• Collaborate with providers, office managers, and client contacts via email to gather outstanding documentation; outreach is primarily automated, requiring team members to document notes based on scripts to clarify missing information from providers’ credentialing applications.

• Represent our client with professionalism and a client-centric approach.

• Utilize Salesforce (CRM) and our client's platform as primary tools for workflow management; accurately log all case activities.

• Provide insights on workflow inefficiencies or recurring errors to the Team Lead for process enhancement discussions.

• Complete required training, onboarding milestones, and any compliance certifications within the stipulated timeframe.

⛳️ Requirements

• Minimum of 1 year of direct credentialing operations experience — strong preference for physician and/or advanced practice provider (APP) credentialing.

• Proven ability to manage simultaneous credentialing files across various provider types.

• Experience with CAQH ProView: retrieving profiles, identifying discrepancies and gaps.

• Familiarity with NCQA credentialing standards (CR elements) and/or URAC standards; understanding of PSV requirements and acceptable verification sources.

• Experience in executing or interpreting primary source verifications: state licensing boards, DEA, NPI Registry, NPDB, OIG/SAM exclusion checks.

• Proficient with Google Suite (Gmail, Google Docs, Google Sheets) for daily communication and documentation purposes.

• Experience with Salesforce or a similar CRM for case logging and task management.

• Comfortable working within SaaS-based credentialing platforms; ability to quickly learn new software.

• Basic proficiency in Adobe Acrobat for document review and file assembly.

• Exceptional attention to detail — inaccuracies in credentialing can affect patient safety; precision is essential.

• Strong written communication skills for provider interactions; professional and clear across all communication channels.

• Self-motivated work habits suitable for a fully remote setup; dependable follow-through on tasks without close supervision.

• Collaborative attitude — willing to identify issues early, ask questions, and contribute to process improvements.

🏝️ Benefits

• Remote Work-Home PLUS: Enjoy the flexibility of a fully remote position with the backing of a well-connected team.

• Work Hours: Opportunity to work full-time, including evenings and weekends.