Credentialing Specialist

Job Description

Job Description

Job Overview

We are seeking a Provider Credentialing Specialist to join our team in supporting core credentialing and recredentialing operations for health plan network providers. This role focuses on primary source verification, data integrity, and compliance with industry standards to ensure high-quality care for members.

This is a 100% Remote, contract opportunity with all necessary computer equipment provided.

• Data Management & Entry: Input, update, and maintain accurate practitioner data within the health plan's computer database and storage systems (e.g., OnBase).

• Primary Source Verification: Conduct thorough background checks and primary source verifications, including investigations, requests, and tracking responses from regulatory sources, state medical boards, and accrediting bodies.

• Compliance & Regulations: Maintain a strong working knowledge of National Committee for Quality Assurance (NCQA) standards, National Practitioner Data Bank (NPDB) requirements, and Centers for Medicare & Medicaid Services (CMS) guidelines.

• Communication & Customer Service: Handle high-volume internal and external inquiries via email and phone, serving as a liaison between the organization, IPAs, delegates, and practitioner offices.

• Recredentialing Tracking: Review monthly reports to ensure all assigned health professionals complete recredentialing by targeted deadlines.

• Committee Support: Assist in preparing written summaries and reports regarding adverse actions for the monthly Credentialing Committee meetings.

• Confidentiality: Maintain strict compliance with HIPAA laws, privacy policies, and the confidential handling of all practitioner records.

• Experience: Minimum of 1 year of hands-on experience processing provider credentialing applications.

• Technical Skills: Proficiency in database management, word processing, and spreadsheets.

• Soft Skills: Strong organizational skills, clear written and verbal communication, and the ability to work independently in a remote environment.

• Payer-Side Experience: Prior experience processing credentialing within a health insurance, health plan, or payer setting.

• Regulatory Standards: Strong working knowledge of NCQA standards and state/federal regulatory guidelines.

• Education/Certification: Associate Degree preferred. NAMSS Certified Provider Credentialing Specialist (CPCS) certification is a plus.

• Work Modality: Fully Remote (Equipment provided by client).

• Training Schedule: 8:00 AM - 5:00 PM PST (Monday - Friday) for the first 2-3 weeks.

• Post-Training Schedule: Flexible start/end times between 5:00 AM - 5:00 PM PST.

For California Applicants:

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.

Here at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine.

Our commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers! The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us?

Company Description

Here at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine.\r\n\r\nOur commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers! The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us?