Credentialling Specialist

Job Title: Credentialing Specialist

Location: Remote/possibly in an office if in location where company has an office (Hybrid)

Employment Type: Full-Time

Overview:

We are seeking a highly organized and detail-oriented Credentialing Specialist to join our growing healthcare team. This full-time, role is pivotal in ensuring that our providers are properly credentialed and recredentialed with various payors. The ideal candidate will have extensive experience with CAQH and other credentialing platforms, a deep understanding of payor requirements, and a proactive approach to managing credentialing processes.

This position will also collaborate with our billing team and may assist with related administrative tasks as needed.

Key Responsibilities:

• Manage end-to-end credentialing and recredentialing processes for providers across multiple payors, ensuring compliance with all regulatory and contractual requirements
• Maintain and update provider information in credentialing databases such as CAQH, PECOS, NPPES, and other payor-specific platforms
• Conduct primary source verification of provider credentials, including education, training, licensure, certifications, and work history
• Monitor and track the status of credentialing applications, following up with payors and providers to ensure timely completion
• Develop and maintain a centralized credentialing management system to organize and track all provider documentation and credentialing activities
• Collaborate with the billing department to ensure that credentialing status aligns with billing requirements and timelines
• Stay informed about changes in credentialing standards, regulations, and payor requirements to ensure ongoing compliance
• Assist in the development and implementation of credentialing policies and procedures
• Provide training and support to providers and internal staff regarding credentialing processes and expectations
• Participate in audits and provide documentation as needed to demonstrate compliance
  
  

Additional Responsibilities:

• Provide weekly summary updates to internal leadership and client(s), detailing credentialing status, outstanding items, and progress
• Communicate clearly and consistently with providers to collect any missing documentation
• Ensure timely recovery of all required items to prevent delays in credentialing or recredentialing
• Collaborate with external partners (e.g., MSOs or IPA administrators) as needed to support provider enrollment
  
  

Qualifications:

• Minimum of 5 years of healthcare credentialing experience, including both initial credentialing and recredentialing
• In-depth knowledge of CAQH, PECOS, NPPES, and commercial payor platforms
• Strong understanding of credentialing requirements across Medicare, Medicaid, and commercial payors
• Experience with credentialing software.
• Exceptional organizational skills and attention to detail, with the ability to manage multiple tasks and strict deadlines
• Strong communication skills (written and verbal) with a proactive, solutions-oriented mindset
• Ability to work independently in a remote environment while collaborating effectively with a team
• CPCS (Certified Provider Credentialing Specialist) preferred but not required
  
  

Benefits:

• Competitive salary based on experience
• Health, dental, and vision insurance
• Retirement savings plan with employer match
• Paid time off and holidays
• Opportunities for continuing education and professional development
  
  

To apply, please submit your resume and a cover letter highlighting your relevant experience to: cspiegel@metacareusa.com

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