Position Summary

The Provider Credentialing Specialist is responsible for managing all aspects of provider credentialing, recredentialing, enrollment, and ongoing compliance with federal, state, payer, and organizational requirements. This position ensures healthcare providers are credentialed accurately and timely to prevent delays in patient care and reimbursement.

Schedule

• Monday - Friday, 8:30 AM - 5:00 PM US Pacific Time, with a 30-minute paid lunch and two 15-minute unpaid breaks  (40 hours per week) 

Essential Responsibilities
- Coordinate initial credentialing and recredentialing for physicians, nurse practitioners, physician assistants, and other licensed providers.
- Collect and verify required credentialing documents.
- Perform primary source verification of licenses, DEA registration, board certifications, education, training, work history, OIG, SAM, and state exclusion databases.
- Maintain provider credentialing files in accordance with CMS, and organizational standards.
- Monitor credential expiration dates and proactively obtain renewals.
- Complete and submit Medicare, Medicaid, commercial payer, ACO, and health system enrollment applications.
- Manage CAQH profiles, including attestations.
- Track enrollment status through approval and resolve payer issues.
- Conduct ongoing sanction monitoring and ensure provider compliance.
- Maintain provider databases and generate credentialing reports.
- Support clinical audits and recommend process improvements.

Qualifications
- Provider credentialing experience preferred
- Experience with CMS/Medicare
- Healthcare, physician practice, telehealth, or hospital experience preferred.
- Ability to work independently in a remote or hybrid environment while meeting productivity goals.
- Excellent attention to detail and analytical skills.
- Strong written and verbal communication skills.
- HIPAA and healthcare compliance
- Registered Nurse (RN) preferred to assist with clinical audits if needed

Skills
- Exceptional organizational and time management skills
- Strong communication and customer service
- Problem-solving and critical thinking
- Microsoft Office and credentialing software proficiency

Ideal Candidate Profile
- Proactive, detail-oriented professional who thrives in a fast-paced healthcare environment and is committed to timely credentialing, regulatory compliance, and excellent provider support.

This position plays a critical role in ensuring accurate reimbursement, regulatory compliance, and the successful delivery of high-quality Transitional Care Management services through telehealth.

Independent Contractor Perks

• Health Insurance Coverage
• Permanent work from home
• Immediate hiring

Note

• Please click the "Apply" button to complete your application, including the assessment questions, technical check, and voice recording. Your hourly pay rate will be established based on your performance in the application process; submissions with all requirements fulfilled will receive priority review.

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