Senior Credentialing Representative

Job Summary

Managing end-to-end provider credentialing operations, the full-time Senior Credentialing Representative will work remotely to oversee data entry, provider file preparation, and system loading while ensuring compliance with credentialing standards and resolving complex issues.

Key responsibilities:

• Manage provider enrollment workflows, including submissions, individual enrollments, and revalidations across multiple payers
• Maintain and update provider data across various systems, ensuring accuracy and consistency
• Conduct audits and identify process improvements to enhance operational efficiency and accuracy

Required qualifications:

• High School Diploma/GED
• 4+ years of healthcare provider credentialing experience
• 2+ years of experience with compliance workflows, including NCQA policies
• 2+ years of experience researching payer and government regulatory requirements
• Intermediate proficiency with MS Excel and Word