Credentialing Representative

Job Summary

Supporting provider credentialing across multiple markets, the remote Credentialing Representative will manage end-to-end data entry, conduct audits, and resolve complex issues in a fast-paced environment focused on compliance with NCQA, CMS, and state requirements.

Key responsibilities:

• Process provider applications and re-credentialing, including initial mailing and data entry into the tracking system
• Conduct audits and provide feedback to enhance processes and reduce errors
• Act as a technical resource, demonstrating depth of knowledge in credentialing practices

Required qualifications:

• High School Diploma/GED
• 3+ years of healthcare provider credentialing experience
• 1+ years of experience with compliance workflows, including NCQA policies
• 1+ years of experience in researching government regulatory information
• Intermediate proficiency in MS Excel and Word