Job Overview We are seeking a highly organized and detail-oriented Credentialing Specialist to join our dynamic healthcare team. In this vital role, you will oversee the credentialing and re-credentialing processes for healthcare providers, and employees ensuring compliance with all regulatory standards and payer requirements. Your expertise will help facilitate smooth provider and employee enrollment, maintain accurate credentialing records, and uphold the highest levels of healthcare compliance. This position offers an exciting opportunity to contribute to a mission-driven organization dedicated to delivering exceptional patient care through rigorous credentialing practices. Responsibilities Manage the entire provider and employee credentialing lifecycle, including initial application review, verification, and ongoing re-credentialing activities. Utilize healthcare software applications and medical credentialing software to track provider credentials, licensing, certifications, and payer enrollments efficiently. Review medical credentialing applications for completeness and accuracy, ensuring adherence to NCQA standards, JCAHO accreditation standards, and CMS regulatory compliance. Coordinate with medical offices, payers, and regulatory agencies such as the Centers for Medicare and Medicaid Services (CMS) to facilitate provider enrollment and maintain up-to-date records. Maintain comprehensive databases of provider information while ensuring confidentiality of sensitive data in accordance with healthcare compliance policies. Monitor changes in health regulation policies and state healthcare regulations to ensure ongoing compliance across all credentialing activities. Prepare detailed reports on credentialing status, provider eligibility, and accreditation standards adherence for internal review and audits. Requirements Proven experience in medical credentialing, managed care, or healthcare administration with a strong understanding of health insurance knowledge and payer enrollment processes. Familiarity with medical terminology, healthcare software applications, and database management experience is essential. Knowledge of healthcare compliance standards including NCQA accreditation standards, JCAHO requirements, and CMS regulations is required. Demonstrated ability to review medical credentialing applications thoroughly while maintaining attention to detail under tight deadlines. Excellent organizational skills with the ability to handle confidential information responsibly and securely. Strong communication skills for coordinating with providers, employees and payers, regulatory bodies, and internal teams. Contract management experience within healthcare settings is a plus. Join us in this exciting role where your expertise will directly impact our ability to deliver high-quality healthcare services! We value energetic professionals committed to excellence in credentialing processes that support our mission of improving patient outcomes through rigorous provider verification and compliance adherence.

Pay:

$26.00 - $28.00 per hour Expected hours: 40.0 per week

Benefits:

Dental insurance Health insurance Paid time off Vision insurance

Work Location:

In person