Provider Credentialing Supervisor [Remote]
Gdit
Remote
- Remote job
Public Trust: MBI (T2)
Requisition Type: Regular
Your Impact
Own your opportunity to be on the frontlines of health innovation. Deliver for America’s health agency missions and enhance lives for hundreds of millions every day.
Job Description
Provider Credentialing Specialist Lead
Position Summary
The Provider Credentialing Specialist serves as the operational subject matter expert (SME) supporting the design, implementation, and ongoing development of a government healthcare credentialing program. This role partners with government stakeholders, business teams, and technical resources to translate operational requirements into scalable credentialing workflows while ensuring compliance with CMS, NCQA, organizational policies, and regulatory requirements.
The position is responsible for implementation activities, provider credentialing operations, primary source verification (PSV), committee preparation, workflow documentation, and serving as the primary operational contact for government clients regarding credentialing processes.
Essential Responsibilities
- Serve as the primary operational contact for government stakeholders regarding credentialing operations.
- Support implementation activities for new credentialing processes and system enhancements.
- Document business requirements and translate operational workflows for technical teams.
- Perform initial credentialing and recredentialing activities.
- Complete Primary Source Verification (PSV) for all required credentialing elements.
- Review provider applications for completeness and compliance.
- Prepare credentialing files for committee review.
- Ensure credentialing files meet organizational, CMS, and NCQA standards.
- Develop and maintain standard operating procedures (SOPs).
- Participate in workflow design and process improvement initiatives.
- Assist with User Acceptance Testing (UAT) during system implementations.
- Identify workflow gaps and recommend operational improvements.
- Collaborate with cross-functional teams including IT, compliance, operations, and government stakeholders.
- Maintain credentialing documentation and audit readiness.
- Monitor credentialing timelines and ensure compliance with established turnaround times.
#GDITWTCJOBS
Work Requirements
Years of Experience
3 + years of related experience
* may vary based on technical training, certification(s), or degree
Certification
Travel Required
Less than 10%
Vacancy posted 5 days ago
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