Credentialing Specialist

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

📋 Description

• Oversee the credentialing, recredentialing, and enrollment processes for providers and facilities with insurance payers, encompassing Medicare, Medicaid, and commercial insurance plans.

• Assess credentialing data in Medallion, confirming provider information, credentialing status, and necessary documentation.

• Keep provider profiles in the CAQH system current, including required attestations and supporting documents.

• Aid clinicians with NPI applications and necessary updates.

• Track and monitor professional licenses, certifications, expiration dates, and other essential credentialing documentation.

• Add newly onboarded providers to relevant insurance payer rosters and remove those who have been terminated as needed.

• Manage the tracking of credentialing applications, renewals, outstanding documents, and payer enrollment statuses.

• Facilitate communication with clinicians, insurance representatives, and internal teams to gather information and address credentialing discrepancies.

• Support clinicians with fingerprinting and additional credentialing documentation.

• Ensure the maintenance of confidential, accurate, and well-organized credentialing records in compliance with applicable regulations and company policies.

• Assist with further administrative and compliance-related tasks as required.

⛳️ Requirements

• High school diploma or equivalent is preferred.

• Previous experience in medical office administration, healthcare credentialing, provider enrollment, or a similar healthcare administrative position is preferred.

• Familiarity with CAQH, NPI applications, insurance credentialing, and payer enrollment procedures is preferred.

• Ability to review and interpret provider credentialing records on electronic platforms, including Medallion or similar systems.

• Strong attention to detail, excellent organizational skills, and the capability to manage multiple deadlines effectively.

• Exceptional written and verbal communication skills.

• Proficiency in Microsoft Office applications and electronic record management.

• Ability to work independently in a remote environment while ensuring robust communication and accountability.

• Dedication to safeguarding confidential provider and patient information.

🏝️ Benefits

• Medical, dental, and vision insurance

• Paid time off (PTO) and paid holidays

• 401(k) retirement plan

• Professional development and growth opportunities

• A collaborative and supportive team environment

• Full-time remote work