Credentialing Representative

Job Summary

Supporting provider credentialing remotely, the full-time Credentialing Representative will manage end-to-end data entry, conduct audits, and ensure compliance with NCQA and CMS standards while working in a fast-paced environment.

Key responsibilities

• Process provider applications and maintain accurate data in the tracking system
• Conduct audits to identify errors and recommend process improvements
• Act as a technical resource, demonstrating depth of knowledge in credentialing functions

Required qualifications

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