Credentialing Specialist (Remote)
Skills
- Credentialing process management
- Knowledge of credentialing standards (NCQA, URAC, CMS)
- Strong organizational and detail orientation
- Technical proficiency in CRM, Excel, Word, email, and video conferencing
- Ability to maintain compliance with HIPAA regulations
Responsibilities
- Own the end-to-end credentialing and re-credentialing processes for providers and facilities
- Track and ensure timely completion of credentialing tasks based on regulatory and contractual deadlines
- Submit credentialing and enrollment applications to health plans for Care Team staff
- Monitor and document expirables, including licenses, malpractice insurance, DEA registration, and board certifications
- Maintain accurate provider records and rosters across internal systems, payer directories, and audit documentation
- Support delegated credentialing audits and internal compliance reviews
- Assist with health plan contracting and network participation processes as needed
- Submit and maintain individual and group enrollment applications for Medicaid and Medicare
- Maintain up-to-date information on group enrollment records
Education
- High school diploma or equivalent required
- Relevant credentialing or healthcare certifications preferred
Benefits
- Comprehensive health, vision & dental insurance
- 401k retirement plan
- Monthly $100 work from home expense stipend
- Flexible vacation policy
- Company provides all required equipment for remote work
Average salary estimate
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