Credentialing Specialist – Facility

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

📋 Description

• Assess facility credentialing applications for correctness and thoroughness in accordance with relevant facility and specialty standards.

• Conduct primary source verifications and necessary evaluations, including license checks, CMS Certification Number (CCN), DEA, National Practitioner Data Bank (NPDB), accreditation, and other credentialing assessments.

• Engage with facilities to clarify inquiries, address discrepancies, and collect any missing application details.

• Input, update, and ensure the accuracy of facility information within credentialing systems.

• Solicit and monitor facility recredentialing applications in line with set timelines and internal protocols.

• Track expiration dates for facility licenses, DEA certificates, accreditations, and other essential documents.

• Confirm that facilities comply with regulatory, compliance, and health plan credentialing criteria.

• Compile and deliver monthly summary reports to the Credentialing Committee.

• Analyze federal and state sanction and exclusion reports.

• Produce and share credentialing reports with internal teams.

• Draft and dispatch approval notifications, requests for supplementary information, and termination notices as instructed by the Credentialing Committee.

• Offer credentialing assistance to the contracting department and provide updates on facility credentialing statuses.

• Handle a high-volume workload, prioritize tasks, ensure precision, and complete activities within mandated timelines.

⛳️ Requirements

• High school diploma or equivalent is essential.

• Prior experience in facility credentialing is preferred, especially in supporting health plan credentialing needs.

• Experience in reviewing accreditation, regulatory, and compliance standards for healthcare facilities is advantageous.

• Knowledge of NCQA, CMS, or other health plan credentialing standards is preferred.

• Additional experience or certification in healthcare credentialing is a plus.

• Excellent attention to detail with the ability to maintain accuracy while managing a high-volume workload.

• Familiarity with facility credentialing principles and primary source verification processes, including license, CCN, DEA, NPDB, accreditation, and other necessary facility assessments.

• Strong organizational and time-management capabilities.

• Ability to juggle multiple priorities and meet production requirements in a dynamic environment.

• Proficient in technology and quick to adapt to new systems and tools.

• Competence in Microsoft Excel and Word.

• Ability to work independently while remaining focused and productive in a remote setting.

• Strong verbal and written communication skills.

• Capable of managing confidential information with discretion.

• Flexible, cooperative, and comfortable working with minimal oversight.

• Comfortable using multiple screens, databases, and systems throughout the day.

• Experience with facility accreditation, regulatory, and compliance evaluations is preferred.

• Familiarity with NCQA, CMS, and health plan credentialing standards is beneficial.

• Experience with credentialing databases or software platforms is preferred.

• Dedicated workspace that is free from distractions and background noise.

• Ability to regularly appear on camera for meetings, training sessions, and team collaboration.

• Quick learner when it comes to new technologies.

• Basic knowledge of facility credentialing and primary source verification processes is strongly preferred.

• Must possess legal authorization to work without visa sponsorship, as the company is unable to provide visa sponsorship.

🏝️ Benefits

• Provision of necessary equipment by the company, including dual monitors.

• Comprehensive training on the company’s credentialing platform.

• Flexible remote work arrangement.

• Commitment to Equal Employment Opportunity.