Delegated Credentialing Specialist

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

📋 Description

• Initiate and facilitate the application processes for practitioners by sending, receiving, analyzing, and importing their documents and data.

• Ensure accurate data entry while maintaining the integrity of the credentialing database.

• Enroll providers with Medicare, Medicaid, as well as state and federal commercial health plans.

• Update CAQH and NPI information in alignment with client practice details.

• Collect, verify, and assess confidential practitioner credentials in accordance with departmental guidelines and accreditation standards.

• Address inquiries from practitioners, client health plans, and internal stakeholders.

• Monitor expiring licenses, board certifications, and other documents with expiration dates.

• Maintain both paper and electronic data files for practitioners and submit their data through CAQH.

• Collaborate with clients, the department manager, and external agencies to ensure smooth credentialing transitions.

• Resolve credentialing discrepancies with practitioners and both internal and external entities.

• Conduct initial credentialing and recredentialing verifications, ensuring timely file handoff or review and approval.

• Perform sanctions and compliance monitoring, promptly notifying the Manager of any negative findings.

• Participate in team meetings and initiatives aimed at process improvement.

• Keep the Manager updated on any credentialing or enrollment issues.

• Contribute positively to the workplace culture.

⛳️ Requirements

• Proficient in using payor websites including CAQH, Pecos, NPI/NPPES, Availity, NaviNet, and CMS I&A.

• Skilled in utilizing software for provider applications, credential verification, and tracking verification statuses.

• Experienced with payor enrollment processes for MD/DO, NP, PhD, PT, OT, LCSW, OD, DDS, DPM, and other licensure levels across medical, dental, vision, behavioral health, and physical health specialties.

• Knowledgeable about primary source verification and the relevant regulations, accreditation requirements, and compliance standards.

• 3-5 years of experience with medical credentialing processes, policies, procedures, and delegated credentialing requirements.

• A minimum of 3 years’ experience in provider credentialing within a healthcare environment.

• Excellent verbal and written communication skills.

• Ability to work under tight deadlines and adapt to changing demands.

• Detail-oriented with a knack for identifying critical information in credentialing documents.

• Strong problem-solving, critical thinking, and deductive reasoning skills.

• Capable of maintaining quality and production expectations.

• Willingness to learn and utilize credentialing and related databases.

• Ability to manage sensitive and confidential information with discretion and trust.

• Proficient in the MS Office suite.

• Associate’s degree or an equivalent combination of education and/or experience.

• Certification as a Provider Credentialing Specialist (CPCS) is preferred.

• Provider Enrollment Specialist Certificate (PESC) is preferred.

🏝️ Benefits

• Flexible work schedules, including options for remote work.

• Award-winning training and development programs.

• Competitive compensation.