Credentialing Specialist

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

📋 Description

• Complete the initial credentialing and recredentialing applications for providers with both commercial and government payers.

• Ensure accurate provider information is maintained in credentialing databases, payer portals, and internal systems.

• Manage CAQH profiles, including necessary updates and re-attestations, while coordinating with payers.

• Monitor the statuses of applications, as well as license and certification expirations, renewals, and insurance contracts.

• Communicate with providers to gather documentation and resolve any discrepancies.

• Collaborate with billing teams to avoid credentialing delays that could impact claims processing or payment.

• Respond to payer requests for additional documentation or clarification as needed.

• Ensure adherence to federal, state, and payer-specific credentialing requirements and timelines.

• Conduct audits of credentialing records to ensure data integrity and compliance with internal policies.

• Maintain logs and reports on credentialing activities, status updates, and effective contract dates.

• Serve as a liaison between providers, payers, and regulatory agencies to facilitate timely reimbursement.

⛳️ Requirements

• High school diploma or equivalent is required.

• An associate or bachelor’s degree in healthcare administration or a related field is preferred.

• A minimum of 2 years of experience in healthcare credentialing or provider enrollment is necessary.

• Experience with commercial and government payers is preferred.

• Proficiency in credentialing software and payer portals, including CAQH and PECOS, is essential.

• Strong skills in Microsoft Office Suite, especially Excel and Outlook, are required.

• A solid understanding of credentialing standards, payer requirements, and basic billing processes is needed.

• Knowledge of HIPAA and healthcare compliance regulations is important.

• Familiarity with claim adjudication, payment posting, and denial management processes is beneficial.

• Excellent verbal and written communication skills are a must.

• Ability to work collaboratively with employees, management, and external customers is essential.

• Capability to manage multiple credentialing timelines, follow-ups, and renewals is necessary.

• Must maintain confidentiality and comply with regulatory and privacy standards.

• Ability to perform office activities, including prolonged sitting, computer-based work, filing, and lifting/carrying office supplies.

• Occasionally able to lift and/or move 20–25 pounds.

• Travel may be required to existing or new OCP locations.

🏝️ Benefits

• Fully remote work arrangement.

• Reasonable accommodations for individuals with disabilities.