Credentialing Specialist

Job Summary

To support a growing dermatology network, the full-time remote Credentialing Specialist will oversee all aspects of credentialing, re-credentialing, and payer enrollment processes for providers, ensuring compliance and timely onboarding in collaboration with operational leaders.

Key responsibilities:

• Oversee provider credentialing and payer enrollment processes for the assigned region
• Ensure compliance with health plan requirements related to provider certification and credentialing
• Manage data maintenance in credentialing databases and prepare management reports for assigned regions

Required qualifications:

• Bachelor's degree in a related field preferred
• Minimum of three years' experience in managed care credentialing or medical staff service setting required
• Strong knowledge of NCQA, Joint Commission, URAC, CMS, and state laws related to credentialing
• National or multi-state credentialing experience preferred
• Ability to work independently in a matrix environment