Job Description

Job Description

Job Description

Pay: $20.00 - $30.00 per hour

Job description:

Credentialing Specialist

Pay: Up to $30/hr, depending on experience.

Location: Remote (must be in the Eastern Time Zone; no NY or CA).

Schedule: M-F, 40 hours/week, 9 AM EST start time.

Are you an experienced Credentialing Specialist ready for a new challenge? Our client is looking for a highly skilled professional to join our team in a temp-to-perm, remote role.

This is a fast-paced, high-volume environment, so we need someone who can hit the ground running. You'll be the point person for all things credentialing, from initial applications to re-credentialing cycles and compliance audits. If you're detail-oriented, have a knack for process improvement, and know your way around CMS, MD Staff, Adobe Pro, and Excel , we want to hear from you.

What You'll Do:

• Manage the credentialing process from start to finish, ensuring all applications are complete and accurate.
• Keep our provider database up-to-date and compliant.
• Serve as a key resource for our CVO and PHSO teams.
• Help prepare for NCQA audits and make sure we're always following the rules.
• Work with providers to gather documentation and keep them informed.
• Assist with committee meetings, reports, and follow-up activities.

What You'll Need:

• At least 3 years of experience in a health insurance or healthcare setting.
• 5+ years of professional secretarial, administrative, or credentialing experience.
• Hands-on experience with CMS, MD Staff, Adobe Pro, and Excel.
• In-depth knowledge of NCQA guidelines.
• Exceptional organizational skills and an eagle eye for detail.
• A proven ability to communicate effectively and solve problems independently.

Bonus Points:

• An Associate's or Bachelor's degree in a related field.
• NCQA & NAM certifications.

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