Credentialing Specialist

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

📋 Description

• Oversee the entire credentialing lifecycle for physicians and advanced practice providers, encompassing initial onboarding, primary source verification, re-credentialing, and continuous monitoring.

• Accurately verify education, training, licenses, board certifications, malpractice insurance, and work history.

• Ensure that all credentialing files comply with NCQA, TJC, CMS, and payer-specific standards.

• Prepare, submit, and track enrollment applications with commercial payers such as BCBS, UHC, Aetna, and Cigna, in addition to Medicare and Medicaid.

• Manage CAQH ProView, including quarterly attestations and document upkeep.

• Process Medicare enrollments and updates via PECOS.

• Establish structure in areas that currently lack consistent processes.

• Organize credentialing inputs from various sources and convert them into clear workflows, trackers, and checklists.

• Monitor effective dates and panel statuses, providing updates to internal stakeholders.

• Maintain precise provider data across CAQH, PECOS, payer portals, and internal systems.

• Ensure all credentialing records are continuously audit-ready with complete and current documentation.

• Track and monitor expiring state licenses, DEA registrations, malpractice insurance, and board certifications.

⛳️ Requirements

• 2 to 3 years of direct experience in medical credentialing or payer enrollment.

• Familiarity with CAQH, PECOS, payer portals, and credentialing software platforms.

• Strong knowledge of NCQA, TJC, CMS, and standard credentialing requirements.

• Proven ability to bring order to complex or unstructured environments and develop scalable processes.

• Quick to identify inconsistencies and maintain clean, accurate files.

• Persistent and professional in obtaining documentation or addressing gaps.

• Excellent written and verbal communication skills, clear and confident.

• Comfortable navigating multiple systems and embracing new tools.

• Capable of handling PHI and sensitive information with utmost discretion.

• Process-oriented, organized, proactive, resourceful, and dedicated to continuous improvement.

🏝️ Benefits

• Competitive salary with benefits, based on experience.