Credentialing Specialist

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

📋 Description

• Complete the credentialing and re-credentialing applications for physicians, ancillary providers, facilities, or groups with third-party payers as well as governmental programs, including Medicare and Medicaid.

• Conduct Primary Source Verification services, which include verifying licenses, malpractice history, and work experience.

• Execute Primary Source Verification file audits upon request.

• Create, update, and maintain CAQH profiles for providers.

• Manage the Credentialing database with payer identification numbers and their effective dates.

• Collaborate with client liaisons and billing teams to refresh provider enrollment statuses.

• Reach out to payers to follow up on submitted applications.

• Address inquiries from physicians, staff, hospitals, and managed care organizations.

• Communicate with providers or their designees to gather credentialing information and necessary documentation.

• Keep clients informed about the process and communicate any delays that arise.

• Update Credentialing leadership on project statuses and assist in managing deliverables and deadlines.

• Precisely log billable and non-billable hours using time and attendance software.

⛳️ Requirements

• A high school diploma is required.

• A bachelor’s degree is preferred.

• 2-3 years of relevant experience in healthcare is required, including specialized skills in Credentialing and/or Medical Billing.

• Certification as a Provider Credentialing Specialist (CPCS) or as a Certified Professional in Medical Staff Service Management (CPMSM) is a plus.

• Capability to work independently as well as in a team environment.

• Outstanding organizational and time management abilities to handle priorities and deadlines effectively.

• Strong verbal, interpersonal, and written communication skills.

• Excellent attention to detail and commitment to quality.

• Proficient in Microsoft Office Suite (Word, Outlook, Teams) and Adobe; Excel knowledge is preferred.

• Minimal travel is required, less than 10% annually.

🏝️ Benefits

• Eligible employees can access benefits that promote physical, mental, career, social, and financial well-being.

• Reasonable accommodations are provided for the application, interview, and job performance processes.

• An equal employment opportunity workplace.

• A focus on learning, development, and a culture of well-being.