Credentialing Specialist

Are you a detail-oriented professional with a passion for compliance and healthcare excellence? We are seeking a disciplined and proactive Credentialing Specialist to join our client's team in the East End. In this role, you will be the guardian of our provider standards, ensuring that every clinician is fully vetted, compliant, and ready to provide care. You’ll be responsible for the primary source verification of healthcare providers, ensuring they are properly enrolled with insurance payers and compliant with all regulatory standards. In a medical billing environment, your accuracy directly impacts the company’s ability to submit claims and get providers paid. Qualifications:

• 2+ years of experience in healthcare credentialing or medical staff services is preferred.
• Familiarity with credentialing software and a solid understanding of healthcare accreditation standards
• The ability to follow up effectively with providers and agencies to keep applications moving forward

salary: $22 - $25 per hour
shift: First
work hours: 8 AM - 5 PM
education: High School

Responsibilities

Key Responsibilities

• Provider Enrollment: Manage the end-to-end enrollment process for providers with Medicare, Medicaid, and commercial insurance payers.

• Primary Source Verification: Verify provider credentials including medical licenses, DEA certifications, board certifications, and educational background.

• Contracting Support: Coordinate with insurance networks to initiate and track the status of participating provider agreements.

• Data Maintenance: Track expiration dates for licenses and certifications to ensure zero lapses in coverage.

• Issue Resolution: Troubleshoot enrollment-related claim denials and communicate with payers to resolve credentialing discrepancies.

• Compliance: Ensure all provider files meet NCQA (National Committee for Quality Assurance) and Joint Commission standards.

Skills

• Claims Processing
• ICD-10
• Medical Billing
• Microsoft Office
• Credentialing (2 years of experience is required)
• Compliance (2 years of experience is required)

Qualifications

• Years of experience: 3 years
• Experience level: Experienced

Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad.

Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact View email address on randstadusa.com.

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).

This posting is open for thirty (30) days.