Remote Healthcare Credentialing Specialist

7 days ago

Dumaguete, Central Visayas, Philippines beBeeCredentialing Full time $75,180 - $111,700

We are seeking an experienced Credentialing Specialist to join our team.

The ideal candidate will have a strong background in healthcare credentialing, with a proven track record of success in managing the credentialing and enrollment processes for healthcare providers. A thorough understanding of Maryland state regulations, insurance guidelines, and national accreditation standards is essential.

Key Responsibilities:
  • Credentialing and Enrollment: Manage the credentialing and recredentialing processes for Maryland-based healthcare providers, including physicians, nurse practitioners, and allied health professionals.
  • Provider File Management: Ensure all provider files comply with Maryland state regulations, insurance guidelines, and national accreditation standards.
  • Application Submission: Complete and submit credentialing applications and enrollment forms to commercial payers, Medicaid, and Medicare (via PECOS).
  • Database Maintenance: Maintain and update provider data in credentialing systems such as CAQH, NPPES, and internal databases.
  • Expirety Tracking: Track and monitor expirable items such as licenses, certifications, and recredentialing deadlines.
  • Communication: Communicate professionally with insurance companies, government agencies, and internal departments to resolve credentialing-related issues.
Qualifications:
  • Healthcare Experience: Prior experience in healthcare credentialing or provider enrollment, preferably with Maryland-based providers.
  • Credentialing Knowledge: Familiarity with Maryland-specific credentialing standards, including Maryland Medicaid and regional payers (e.g., CareFirst, Maryland Physicians Care).
  • Platform Proficiency: Proficiency with credentialing platforms such as CAQH, PECOS, and NPPES.
  • E-Portal Familiarity: Familiarity with the EPREP Portal (Maryland Emergency Preparedness and Response Portal), including provider registration and compliance functions.
  • Attention to Detail: Exceptional attention to detail and the ability to manage multiple deadlines effectively.
  • Communication Skills: Strong written and verbal communication skills; professional in interactions with both internal and external stakeholders.
  • Reliability: Self-motivated and reliable in a fully remote work environment.
  • Confidentiality: Demonstrated commitment to confidentiality and compliance with healthcare regulations.

We offer a competitive compensation package and a dynamic work environment.

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