Credentialing Specialist

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

📋 Description

• Oversee the complete cycle of credentialing and re-credentialing processes for clinical and ancillary providers.

• Execute primary source verifications of licenses, educational background, training, certifications, and employment history.

• Gather, review, and manage credentialing documentation and provider files.

• Upload and preserve documentation within the MD-Staff-approved credentialing software system.

• Perform NPDB queries, sanctions checks, background checks, and other necessary screenings.

• Prepare and submit credentialing packets to military treatment facilities and relevant governing or oversight organizations.

• Facilitate provider privileging and appointment processes in collaboration with military treatment facility personnel and other stakeholders.

• Monitor licenses, certifications, and expirable credentials to guarantee timely renewals and ongoing compliance.

• Engage with providers and third-party organizations to acquire missing or incomplete documentation.

• Conduct regular audits of credentialing files to ensure accuracy, completeness, and compliance.

• Collect, analyze, and present credentialing data and compliance metrics.

• Generate reports regarding credentialing status, timelines, and compliance.

• Identify opportunities for process improvements and provide recommendations.

• Stay updated on credentialing requirements, regulations, standards, and best practices.

• Carry out additional duties as assigned.

⛳️ Requirements

• High school diploma or equivalent.

• Minimum of one (1) year of experience in healthcare credentialing.

• Experience in processing credentialing applications, primary source verifications, and compliance documentation.

• Prior experience with MD-Staff software is highly desirable.

• Knowledge of credentialing processes, primary source verification, and regulatory compliance.

• Familiarity with healthcare accreditation standards and credentialing best practices.

• Strong attention to detail and capacity to manage high-volume, deadline-oriented workflows.

• Proficient in Microsoft Office as well as credentialing and/or database systems.

• An associate degree in Healthcare Administration, Business Administration, or a related field is preferred.

• Experience with DoD, DoW, or DHA credentialing requirements and systems is preferred.

• Background in supporting credentialing activities at a military treatment facility is preferred.

• Credentialing certification such as Certified Provider Credentialing Specialist (CPCS) is preferred.

• Familiarity with NCQA and/or Joint Commission standards is preferred.

• Experience with additional credentialing software platforms is preferred.

• Ability to manage multiple providers, requirements, deadlines, and expiring credentials.

• Capable of professional communication with providers, government personnel, internal stakeholders, and external organizations.

• Ability to prioritize competing deadlines in a fast-paced environment.

• Skill in identifying missing information and resolving issues.

• Understanding of confidentiality and the protection of sensitive provider and healthcare information.

🏝️ Benefits

• Part-time contract position.

• 15 to 25 hours per week, not to exceed 30 hours per week.

• Opportunity to support programs that benefit Service Members and their families.

• Collaborate as part of a professional team committed to quality, compliance, and exceptional service.