Provider Credentialing Specialist II

This is a fully remote position, open to applicants in Alabama, +25 more states.

📋 Description

• Manage specific components of credentialing and re-credentialing for a managed care organization.

• Comply with standards set by the National Committee for Quality Assurance as well as state and federal regulations.

• Review, investigate, and carry out primary source verifications.

• Credential various providers including facility, ancillary, medical, and behavioral professionals.

• Complete credentialing tasks efficiently and within established timelines.

• Operate under the guidance of a Credentialing Supervisor/Manager.

⛳️ Requirements

• High school diploma or equivalent is mandatory.

• A minimum of 2 years of relevant experience is required.

• Comprehensive understanding of managed care provider credentialing and re-credentialing principles, methods, regulations, and procedures.

• Direct experience with a Credentials Verification Organization (CVO), MCO, HMO, or a hospital-based credentialing organization.

• CPCS – Certified Provider Credentialing Specialist certification is preferred.

• Experience with Credential Stream is advantageous.

• Familiarity with MDStaff or Cactus is preferred.

• No specific certification or license is required.

• Must be available to work from 8 AM to 5 PM EST, Monday through Friday.

🏝️ Benefits

• Medical, Dental, and Vision plans.

• Adoption, Fertility, and Surrogacy Reimbursement up to $10,000.

• Paid Time Off and Sick Leave.

• Paid Parental & Family Caregiver Leave.

• Emergency Backup Care.

• Long-Term, Short-Term Disability, and Critical Illness plans.

• Life Insurance.

• 401k/403B with Employer Match.

• Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education.

• Student Debt Pay Down – $10,000.

• Pet Insurance.

• Legal Resources Plan.

• Opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria are met.

• Professional development and a commitment to continued employment philosophy.