Credentialing Specialist

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

📋 Description

• Supervise the credentialing of providers and the enrollment processes with third-party payers and hospital/health system partners in a designated region.

• Ensure adherence to health plan specifications related to provider certification and credentialing.

• Regularly meet with regional operational leadership to facilitate the prompt onboarding of new providers and address credentialing requirements.

• Keep provider information current in credentialing databases and online platforms.

• Guarantee the timely renewal of licenses, certifications, and credentialing.

• Uphold the confidentiality of provider information.

• Aid in the management of information flow among payers, contracted PHOs, ACOs, and other QualDerm networks.

• Coordinate and generate management reports for assigned regions.

• Oversee process and quality improvement initiatives related to payer enrollment, data entry, credentialing committees, and credentialing/enrollment activities.

• Engage in the training of new Credentialing & Enrollment team members.

⛳️ Requirements

• Bachelor’s degree in a related field is preferred.

• A minimum of three (3) years of experience in managed care credentialing or within a medical staff service setting is required.

• Experience with national or multi-state credentialing is preferred.

• Proven skills in analysis, problem-solving, and resolution.

• Ability to communicate effectively and appropriately with practitioners and providers, especially concerning sensitive and confidential information.

• Strong understanding of NCQA, Joint Commission, URAC, CMS, and state laws and regulations concerning the credentialing of QualDerm providers.

• Capability to prioritize tasks and meet ongoing deadlines for timely completion.

• Ability to work independently within a matrix environment.

• Must be authorized to work in the United States on a full-time basis.

🏝️ Benefits

• Competitive Pay – Attractive compensation to reward your hard work.

• Comprehensive Health Coverage – Includes Medical, Dental, and Vision plans to keep you covered.

• Generous 401(k) Plan – Company matches 100% of the first 3%, plus 50% of the next 2%, with immediate vesting.

• Paid Time Off (PTO) – Accrue PTO from day one, plus enjoy 6 paid holidays and 2 floating holidays each year.

• Company-Paid Life Insurance – Basic life coverage, with the option for additional plans.

• Disability Protection – Short-term and long-term disability coverage.

• Additional Wellness Plans – Accident, critical illness, and identity theft protection plans.

• Employee Assistance Program (EAP).

• Exclusive Employee Discounts.

• Referral Bonus Program.