Credentialing Specialist
New
Remote, USAFull-TimeMiddle
Salary39000 - 48150 USD per year
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Job Details
- Experience
- 1+ year
- Required Skills
- Microsoft Office
Requirements
- High school diploma, GED, or equivalent
- 1+ year of experience in healthcare operations, credentialing, or a related field
- Familiarity with health plan or credentialing systems
- Proficiency in Microsoft Office
- Proficiency in Adobe Acrobat
- Strong verbal and written communication skills
- Exceptional attention to detail and commitment to accuracy
- Strong organizational, multitasking, and time-management skills
- Ability to prioritize workload and meet deadlines
- Associate or Bachelor’s degree in healthcare administration, public health, or a related field (preferred)
- Credentialing or licensure experience (preferred)
- Working knowledge of industry standards and regulations (e.g., NCQA, state and federal requirements) (preferred)
Responsibilities
- Coordinate and execute credentialing and re-credentialing activities for contracted providers and HDOs
- Monitor ongoing provider compliance, professional license sanctions, and quality indicators
- Maintain accurate, complete, and timely credentialing records within credentialing software systems
- Prepare, validate, and submit credentialing data files to the CVO
- Review, validate, and document the accuracy of CVO completed work
- Communicate effectively with providers, physicians, vendors, and internal stakeholders
- Partner cross-functionally with contracting, client services, and internal departments
- Prepare Credentialing Committee materials, including documentation of issues and resolutions
- Assist with monthly file sampling, audits, SDMC/QMC reporting, and re-credentialing reports
- Ensure strict confidentiality of privileged and sensitive information
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