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, and groups associated with third-party payers and governmental programs.

• Conduct Primary Source Verification services, which include verifying licenses, malpractice history, and work history, along with performing file audits.

• Create, update, and maintain CAQH provider profiles.

• Manage the Credentialing database, ensuring payer identification numbers and effective dates are current.

• Collaborate with client liaisons and billing departments to refresh provider enrollment status.

• Reach out to payers to follow up on applications that have been submitted.

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

• Engage with providers or their designees to gather necessary credentialing information.

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

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

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

⛳️ Requirements

• A high school diploma is required; a bachelor’s degree is preferred.

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

• Certification as a CPCS or CPMSM is advantageous.

• Capability to work both independently and collaboratively within a team.

• Outstanding organizational and time management abilities.

• Strong verbal, interpersonal, and written communication skills.

• High level of attention to detail and quality assurance.

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

• Minimal travel requirement of 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 process, interviews, or job functions.

• Opportunities for learning, development, and well-being programs are offered.

• We foster a diverse and inclusive workplace culture.