Credentialing Specialist – Enrollment

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

📋 Description

• Process initial credentialing and recredentialing applications to comply with regulatory standards.

• Review and evaluate credentialing applications along with supporting documents to ensure accuracy and completeness.

• Validate and confirm provider credentials, including but not limited to licensure, DEA, specialty board certifications, and professional liability.

• Identify discrepancies, conduct necessary research, follow up, and escalate any unresolved issues.

• Complete the payer provider enrollment processes and manage revalidations.

• Maintain CAQH profiles, NPPES registrations, and provider data with payers.

• Oversee plan enrollment status within the credentialing system.

• Perform additional duties as assigned.

• Provide on-site support to member organizations for new software installations as needed.

• Travel nationally based on the business requirements of OCHIN.

⛳️ Requirements

• A minimum of two (2) years of progressive experience in Credentialing and/or Provider Enrollment is preferred.

• Preferred in-depth knowledge of credentialing, privileging, and provider enrollment standards (HRSA, FTCA, TJC, NCQA, etc.).

• Certification as a Provider Credentialing Specialist (CPCS) may be required or strongly preferred.

• Familiarity with credentialing software and data management systems is preferred.

• Experience with MD-Staff is preferred.

• Advanced proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, etc.) is preferred.

• Working knowledge of Smartsheet, including data structure, formula creation, basic workflows, and automation is preferred.

• Proven experience in client-facing roles, with the ability to build relationships and effectively communicate with diverse stakeholders is preferred.

• Familiarity with Jira for issue tracking and task management is preferred.

• Ability to work independently and efficiently from a home office environment.

• Access to high-speed internet service is required.

• Capability to maintain a distraction-free workplace.

• Must be legally authorized to work in the United States on a permanent basis at the time of application.

• This position is not eligible for employment visa sponsorship now or in the future.

• Candidates may be required to complete a pass/fail computer literacy assessment and a competency evaluation.

🏝️ Benefits

• Competitive compensation package.

• Healthy work-life balance.

• Opportunities for professional growth.

• Remote work from home flexibility.

• Support for high-speed internet service requirements.

• Comprehensive benefits package (details available on the OCHIN website).

• Immunization support and encouragement, including COVID-19 and influenza vaccinations.