Credentialing Specialist

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

📋 Description

• Oversee the complete credentialing and recredentialing process for providers across designated client accounts.

• Prepare, submit, and monitor applications for payer enrollment and participation with Medicare, Medicaid, and commercial health plans.

• Confirm provider credentials, which include licenses, NPI, DEA, malpractice history, CAQH profiles, and board certifications.

• Keep meticulous and organized records of credentialing activities in internal databases and client systems.

• Liaise with providers, payers, and internal teams to address any credentialing issues or delays.

• Track upcoming expirations and initiate timely renewals to guarantee uninterrupted network participation.

• Work in conjunction with contracting and billing teams to ensure provider enrollment aligns with payer contracts and claim submission readiness.

• Remain updated on payer policies, CMS, and NCQA credentialing standards to maintain compliance.

• Create credentialing status reports and update internal leadership and client contacts accordingly.

⛳️ Requirements

• Preferred Associate’s or Bachelor’s degree in Healthcare Administration or a related field.

• At least 2 years of experience in credentialing or provider enrollment, ideally within an RCM vendor or multi-client environment.

• Knowledge of Medicare/Medicaid enrollment processes, PECOS, CAQH, and payer portals.

• Strong organizational and documentation skills with a keen attention to detail.

• Excellent written and verbal communication abilities.

• Capability to manage multiple client accounts and meet deadlines concurrently.

• Proficient in Microsoft Office and credentialing/enrollment software.

• CPCS (Certified Provider Credentialing Specialist) or CPMSM (Certified Professional Medical Services Management) certification preferred but not mandatory.

• Must uphold the confidentiality of provider and client information at all times.

🏝️ Benefits

• Full-time employment.

• Remote work environment.

• Opportunities for professional growth.

• Access to cutting-edge technology.

• Engagement in cross-functional collaboration.