Provider Credentialing Specialist

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

📋 Description

• Oversee daily credentialing and recredentialing processes.

• Assist with regulatory compliance, provider onboarding, and program preparation.

• Work in collaboration with providers, internal credentialing teams, quality personnel, and operational leaders.

• Ensure that applications, verifications, and documentation are thorough and accurate.

• Conduct Primary Source Verification (PSV).

• Confirm licensure and certifications.

• Organize provider files for committee evaluation.

• Keep precise provider records.

• Utilize credentialing systems, quality review methods, CMS and NCQA regulatory standards, and best practices in documentation.

• Facilitate high-quality provider management operations.

⛳️ Requirements

• A high school diploma is mandatory; an associate or bachelor’s degree is preferred.

• Minimum of 1 year of relevant experience.

• Preferred 2+ years of experience in healthcare credentialing.

• Familiarity with initial credentialing, recredentialing, Primary Source Verification (PSV), credentialing documentation standards, regulatory compliance (CMS, NCQA), and provider onboarding processes.

• MB(T2) security clearance is required.

• U.S. citizenship is necessary.

• Strong attention to detail is essential.

• Excellent organizational and communication abilities.

• Capacity to meet deadlines, uphold confidentiality, and collaborate effectively with providers and internal teams.

• Travel required is less than 10% as necessary.

🏝️ Benefits

• Comprehensive medical plan options, including those with Health Savings Accounts.

• Options for dental plans.

• Options for vision plans.

• 401(k) plan with company matching contributions.

• Flexible full-work weeks.

• Paid time off that includes vacation, sick leave, personal time, holidays, paid parental leave, military leave, bereavement leave, and jury duty leave.

• New employees receive 15 days of paid leave per calendar year, prorated based on hire date.

• 10 paid holidays each year.

• Eligible employees can receive up to 160 hours of paid family leave within a rolling 12-month period.

• Short- and long-term disability benefits.

• Life insurance coverage.

• Accidental death and dismemberment insurance.

• Personal accident insurance.

• Critical illness insurance.

• Business travel and accident insurance.

• AI-driven career tool that identifies career advancement steps and learning opportunities.

• Internal mobility team dedicated to supporting career objectives.

• Recognized for an award-winning culture of innovation and a military-friendly workplace.