Provider Credentialing Specialist

Job Summary

Responsible for credentialing and re-credentialing processes, the full-time remote Provider Credentialing Specialist will review and process primary source verifications for various healthcare providers while adhering to regulatory standards.

Key responsibilities

• Manage the credentialing and re-credentialing processes for a managed care organization
• Review and investigate primary source verifications for facility, ancillary, medical, and behavioral providers
• Ensure compliance with National Committee for Quality Assurance and state and federal regulations

Required qualifications

• High School diploma or equivalent
• Minimum of 2 years of relevant experience in managed care provider credentialing
• Knowledge of credentialing principles, methods, and regulations
• Experience with Credential Stream or similar credentialing programs is preferred
• CPCS certification is preferred