Credentialing Specialist - Remote

Overview

OpenLoop is looking for a Credentialing Specialist to join our team remotely. This role will be a member of the Credentialing & Licensing Team, collaborating closely with the Credentialing & Licensing Manager. The Credentialing Specialist is responsible for managing the credentialing and recredentialing processes for healthcare providers in accordance with our NCQA-accredited Credentialing Verification Organization (CVO) guidelines. This role ensures that all providers meet the necessary qualifications and maintain compliance with industry standards. You will collaborate closely with clinicians, compliance teams, and regulatory bodies to facilitate timely and accurate credentialing submissions and renewals, thereby supporting the delivery of high-quality patient care.

In Short

• Credentialing Management: Review and complete initial and renewal credentialing applications for healthcare providers across multiple practices, ensuring adherence to State, Federal, and NCQA CVO guidelines.
• Verify provider credentials, including education, training, licensure, certifications, and work history.
• Documentation and Database Maintenance: Maintain and update credentialing documentation in the company’s credentialing database.
• Ensure all credentialing records are accurate, complete, and up-to-date.
• Tracking and Monitoring: Monitor the status of credentialing applications and provider files, ensuring timely renewals and proactive follow-ups.
• Track key credentialing metrics and generate reports on credentialing statuses and compliance.
• Communication and Coordination: Serve as a point of contact for providers regarding credentialing inquiries and status updates.
• Ensure all credentialing activities comply with state/federal regulations, board requirements, and NCQA standards.
• Problem Resolution: Identify and resolve any issues or discrepancies in credentialing documents and processes.
• Process Improvement: Proactively identify opportunities to enhance the credentialing process and implement best practices.

Requirements

• 1-2 years of experience in healthcare credentialing, regulatory compliance, or a related field.
• Familiarity with NCQA CVO guidelines and multi-state credentialing processes is highly desirable.
• Detail-oriented with strong organizational and time-management skills.
• Excellent communication skills, both written and verbal, for effective interaction with providers and regulatory bodies.
• Experience with provider data management systems such as MDStaff.
• Proficiency in using credentialing software and E-Ticketing systems (e.g., Jira, Zoho Desk) is a plus.
• Strong analytical and problem-solving abilities.
• Ability to work independently and collaboratively within a team environment.
• Commitment to maintaining confidentiality and adhering to ethical standards in handling provider information.
• Certification in Credentialing (e.g., Certified Provider Credentialing Specialist) is advantageous.

Benefits

• Medical, Dental, and Vision plans
• Flexible Spending/Health Savings Accounts
• Unlimited PTO
• 401(k) + Company Match
• Life Insurance, Pet insurance, and more