Credentialing Specialist - Remote
$48,152–$64,916 year
RemoteUnited States
Job Summary
Oversee all aspects of provider credentialing, re-credentialing, and payer enrollment for an assigned region, ensuring compliance with health plan requirements and timely on-boarding of new providers. Manage processes to maintain up-to-date data in credentialing databases and coordinate information flow between payers, PHOs, and ACOs. Ensure timely renewal of licenses and certifications while maintaining confidentiality of provider information. Coordinate and prepare management reports, lead quality improvement efforts related to enrollment and credentialing committees, and participate in training new team members. This role reports to the Senior Director, Credentialing and Revenue Cycle, supporting QualDerm Partners' mission to educate communities on skin health across 150+ locations.
Required Qualifications
- Minimum of three (3) years' experience in managed care credentialing or medical staff service setting
- Strong knowledge of NCQA, Joint Commission, URAC, CMS and State Laws and regulations as they pertain to the credentialing of QualDerm providers
- Must be able to function independently in a matrix environment
- Applicants must be currently authorized to work in the United States in a full-time basis
Desired Qualifications
- Bachelor's degree in related field preferred
- National or multi-state credentialing experience preferred
- Demonstrated skills in analysis, problem solving and resolution
- Ability to communicate appropriately and effectively with practitioners and providers, including sensitive and confidential information
- Prioritize and meet deadlines on an ongoing basis to ensure timely completion according to process requirements
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