Credentialing Specialist - Remote

Overview

We are seeking a highly organized and detail-oriented Credentialing Specialist to join our growing healthcare team. This full-time, role is pivotal in ensuring that our providers are properly credentialed and recredentialed with various payors. The ideal candidate will have extensive experience with CAQH and other credentialing platforms, a deep understanding of payor requirements, and a proactive approach to managing credentialing processes.

In Short

• Manage end-to-end credentialing and recredentialing processes for providers across multiple payors.
• Maintain and update provider information in credentialing databases.
• Conduct primary source verification of provider credentials.
• Monitor and track the status of credentialing applications.
• Develop and maintain a centralized credentialing management system.
• Collaborate with the billing department on credentialing status.
• Stay informed about changes in credentialing standards.
• Assist in the development of credentialing policies.
• Provide training and support regarding credentialing processes.
• Participate in audits to demonstrate compliance.

Requirements

• Minimum of 5 years of healthcare credentialing experience.
• In-depth knowledge of CAQH, PECOS, NPPES, and commercial payor platforms.
• Strong understanding of credentialing requirements across Medicare, Medicaid, and commercial payors.
• Experience with credentialing software.
• Exceptional organizational skills and attention to detail.
• Strong communication skills with a proactive mindset.
• Ability to work independently in a remote environment.
• CPCS (Certified Provider Credentialing Specialist) preferred but not required.

Benefits

• Competitive salary based on experience.
• Health, dental, and vision insurance.
• Retirement savings plan with employer match.
• Paid time off and holidays.
• Opportunities for continuing education and professional development.