Credentialing Specialist

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

📋 Description

• Oversee the initial credentialing, recredentialing, and provider enrollment procedures.

• Prepare, submit, and track credentialing applications to hospitals, health plans, government payers, and other credentialing bodies.

• Ensure provider information is accurate and up-to-date in credentialing databases.

• Monitor credential expiration dates, including licenses, certifications, DEA registrations, malpractice insurance, and other essential documentation.

• Proactively acquire renewal documentation to avoid lapses in credentialing.

• Keep track of application statuses and follow up with payers and credentialing organizations.

• Ensure compliance with federal, state, payer, and organizational credentialing standards.

• Perform primary source verification in line with accreditation and regulatory requirements.

• Inspect provider files for completeness and correctness prior to submission.

• Assist with provider enrollment, revalidation, and demographic updates for Medicare, Medicaid, and commercial insurance providers.

• Address credentialing inquiries from providers, leadership, clients, and payer representatives.

• Generate credentialing reports and keep leadership updated on status.

• Support audits and accreditation reviews by maintaining organized and compliant provider files.

• Work collaboratively with internal departments to resolve credentialing and enrollment challenges affecting provider participation or reimbursement.

• Safeguard the confidentiality of sensitive provider and organizational data.

• Adhere to credentialing and enrollment timelines, maintain provider participation without interruptions, ensure record accuracy, comply with requirements, and meet service-level agreements and performance metrics.

⛳️ Requirements

• Comprehensive understanding of credentialing, provider enrollment, and recredentialing processes.

• Knowledge of Medicare, Medicaid, and commercial payer regulations.

• Familiarity with CAQH, NPPES, PECOS, and payer enrollment portals.

• Excellent organizational capabilities with the ability to manage multiple deadlines effectively.

• Strong attention to detail and dedication to accuracy.

• Proficient verbal and written communication skills.

• Capability to work independently and prioritize tasks in a fast-paced setting.

• Proficiency in Microsoft Office Suite, including Excel, Word, and Outlook.

• Preferred experience in handling credentialing databases and provider management systems.

• Strong problem-solving abilities and follow-up skills.

• High school diploma or equivalent required.

• At least 2 years of experience in credentialing, provider enrollment, healthcare administration, or a related field.

• An associate or bachelor's degree in healthcare administration, Business Administration, or a related field is preferred.

• Certification as a Provider Credentialing Specialist (CPCS) or a willingness to pursue certification.

• Experience credentialing providers across various states and payer networks.

• Background in healthcare revenue cycle management, physician practice management, or healthcare consulting organizations.

• Remote colleagues based in the US are not allowed to work from any location outside the United States at any time without prior written approval.

🏝️ Benefits

• Fully remote work arrangement.

• Opportunity to collaborate with a talented and motivated team.

• Engagement with cutting-edge technology.

• Continuous opportunities for growth and professional development.