Credentialing Specialist

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

📋 Description

• Handle the initial credentialing applications and reappointment files, ensuring accuracy, completeness, and prompt submission.

• Conduct primary source verification in line with regulatory, accreditation, and payer standards.

• Oversee provider licenses, certifications, registrations, and other necessary credentials to ensure timely renewals and compliance.

• Gather, verify, maintain, and update provider information in credentialing databases and internal systems.

• Identify discrepancies, incomplete documentation, and potential compliance issues; escalate matters as needed.

• Prepare credentialing files and supporting documentation for review by leadership and credentialing committee meetings.

• Keep accurate records and documentation in accordance with organizational policies and regulatory standards.

• Communicate updates regarding credentialing, recredentialing, and provider enrollment status to centers and stakeholders.

• Create reports and track credentialing activities to meet operational and compliance requirements.

• Protect confidential provider information and adhere to privacy and security standards.

• Support organizational priorities and undertake additional duties as assigned.

⛳️ Requirements

• An associate degree is preferred, or a comparable combination of education and experience.

• At least one (1) year of experience in a healthcare-related position is preferred.

• Basic knowledge of provider credentialing, regulatory requirements, and healthcare compliance standards.

• Experience with credentialing software, databases, and internal tracking systems.

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

• Strong attention to detail and dedication to data accuracy and integrity.

• Ability to maintain confidentiality while handling sensitive provider information.

• Effective written and verbal communication skills.

• Strong organizational and time management skills, capable of managing multiple priorities and deadlines.

• Ability to work both independently and collaboratively within a team environment.

• Previous experience in provider credentialing, medical staff services, provider enrollment, or healthcare administration is preferred.

• Experience in a healthcare organization, Federally Qualified Health Center (FQHC), or managed care environment is preferred.

• Familiarity with credentialing and enrollment requirements for commercial, Medicare, and Medicaid health plans is preferred.

• Knowledge of regulatory and accreditation standards concerning provider credentialing is preferred.

• Experience maintaining provider data within credentialing databases and verification systems is preferred.

🏝️ Benefits

• 100% Remote Work

• 100% Employer-Paid Medical Insurance

• Annual $1,500 HSA Contribution

• Generous Paid Time Off (PTO)

• 403(b) Retirement Plan with Employer Contribution

• Professional Development & Education Assistance

• Mission-Driven Culture Focused on Community Health