Credentialing Specialist

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

📋 Description

• Monitor and record changes in credentialing and application statuses with both participating and non-participating payers.

• Input provider information into credentialing databases.

• Address provider data requests from health plan organizations.

• Manage the re-credentialing process for established physicians with commercial and managed care plans, and complete CAQH attestations.

• Handle provider payer applications, re-applications, and attestations, which include mailing, reviewing, and loading into databases.

• Submit applications to various payers and follow up to check on their status.

• Communicate effectively with both internal and external customers, including making operational and payer calls.

• Investigate credentialing-related denials and customer concerns.

• Research payer processes and online participation requirements.

• Compile, review, and submit credentialing and re-credentialing application files to ensure compliance with federal and state standards.

⛳️ Requirements

• High School Diploma or GED.

• Minimum of 1 year of experience in payer enrollment, credentialing, or a related field within a healthcare environment.

• Strong organizational skills and the ability to multitask, with a sharp focus on detail.

• Outstanding communication and interpersonal abilities.

• Proficiency in the Microsoft Office Suite (Excel, Word, PowerPoint).

• Experience with electronic health record (EHR) systems.

• Knowledge of healthcare regulations and payer policies.

• Travel is required rarely or not at all.

🏝️ Benefits

• Comprehensive benefit offerings for eligible employees.