Provider Credentialing Specialist

Job Summary

Working remotely in a full-time capacity, the Provider Credentialing Specialist II will manage credentialing and re-credentialing processes for a managed care organization, ensuring compliance with relevant regulations and conducting primary source verifications for various healthcare providers.

Key responsibilities:

• Review and process credentialing applications and re-credentialing for medical and behavioral providers
• Ensure adherence to National Committee for Quality Assurance, State, and Federal regulations
• Conduct timely and efficient primary source verifications for facility and ancillary providers

Required qualifications:

• High School diploma or equivalent required
• Minimum of 2 years of directly related experience in managed care provider credentialing
• Thorough knowledge of credentialing principles, methods, regulations, and procedures
• Experience with Credential Stream or similar credentialing software preferred
• CPCS certification as a Certified Provider Credentialing Specialist preferred