Remote Senior Credentialing Specialist

Job Summary

A healthcare services and support organization is filling a position for a Remote Senior Credentialing Specialist.

Must be able to:

• Maintain up to date data for each provider in databases
• Perform quality review audits of credentialing files
• Present files to Medical Director or Credentialing Committee as required

Skills and Requirements Include:

• Knowledge of NCQA and CMS regulatory requirements
• 5+ years of experience in managed care credentialing, provider enrollment and/or Medical Staff service setting
• Experience managing CAQH Provider Profiles
• Must comply with HIPAA rules and regulations
• Working knowledge ofpayer credentialing rules and regulations
• Demonstrated skills in problem solving, analysis and resolution