Credentialing Specialist - PT
Location
United States
Posted
56 days ago
Salary
0
Seniority
Mid Level
No structured requirement data.
Job Description
Credentialing Specialist - PT
usebridge.com
Job description The Credentialing Specialist plays a critical role in ensuring the accuracy, efficiency, and compliance of provider credentialing processes within a growing digital health environment. This position is responsible for managing provider credentialing, enrollment, and re-credentialing with health plans, regulatory bodies, and partner organizations. The ideal candidate has a strong understanding of credentialing best practices, compliance requirements, and digital tools to streamline workflows. Key Responsibilities: - Process and manage provider credentialing applications, ensuring compliance with federal, state, and payer requirements. - Maintain accurate and up-to-date provider records within credentialing databases and digital health platforms. - Verify provider credentials, including licensure, certifications, education, training, and work history. - Coordinate with internal teams and external stakeholders to ensure timely credentialing and payer enrollment. - Monitor and track credentialing deadlines, expirations, and re-credentialing requirements. - Identify and implement process improvements using digital tools and automation. - Stay up-to-date with industry regulations, payer policies, and accreditation standards (NCQA, CMS, CAQH, etc.). - Assist with audits, reporting, and data analysis related to provider credentialing and compliance. - Support provider onboarding processes including communicating with providers directly in a professional manner to ensure a seamless experience. Qualifications: - Bachelor's degree in healthcare administration, business, or a related field preferred. - 2+ years of experience in provider credentialing or enrollment within a healthcare or digital health setting. - Experience using Verifiable or Medallion preferred. - Strong understanding of NCQA, CMS, CAQH, and payer credentialing requirements. - Proficiency in credentialing software, databases, and digital health platforms. - Detail-oriented with strong analytical, problem-solving, and organizational skills. - Excellent communication and interpersonal abilities to collaborate with internal teams and external partners. - Ability to manage multiple priorities in an evolving, technology-driven environment. - Experience with automated credentialing workflows and digital process optimization is a plus. Compensation: - $25/ hour - This is a temp to hire role - Full time hours preferred, but part time hours will also be considered.
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