Credentialing Specialist

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

📋 Description

• Build and nurture effective relationships with providers, retail chains, strategic partners, and their teams.

• Inform providers about industry-standard credentialing requirements utilizing team expertise and available resources.

• Develop provider relationships to acquire regulatory information and manage both initial and ongoing credentialing needs.

• Ensure that documentation adheres to relevant state regulations.

• Manage assigned files within the CVO partner’s system.

• Monitor credentialing files and gather missing documents to guarantee timely completion and compliance with regulations.

• Investigate, analyze, and resolve complex credentialing challenges and escalations.

• Collaborate with internal and external business partners to fulfill compliance requirements.

• Collect, assess, and compile data from regulatory reporting agencies, legal documents, and providers regarding sanctions and malpractice claims.

• Assemble information for the Credentialing Committee to aid in provider application decisions.

• Input and maintain provider data while ensuring the integrity of the information.

• Raise issues and facilitate solutions.

• Collect provider information for the legal department’s Dispute Resolution Process.

• Draft professional correspondence to providers, retail chains, and office staff.

• Support organizational growth targets and operational objectives.

• Serve as an internal resource for business partners.

⛳️ Requirements

• Bachelor’s degree in a relevant field; or 4 years of functional experience in place of a degree.

• Proven professionalism and leadership in scenarios involving controversy and conflict.

• Experience in managing and resolving escalated issues.

• Demonstrated advanced communication, influencing, and problem-solving abilities.

• Experience working directly with providers and staff regarding credentialing policies and procedures.

• Regularly exercise discretion and independent judgment.

• Capability to identify problems and propose innovative solutions.

• Strong attention to detail, multitasking, organizational, and customer service skills.

• Established ability to balance provider needs with corporate goals.

• Ability to work autonomously as well as within a team setting.

• For remote or hybrid positions, high engagement in virtual environments, including maintaining a visible presence during meetings.

🏝️ Benefits

• Option for remote work (Work From Home).

• Hybrid work option (partially onsite at a VSP location and Work From Home).