Healthcare Credentialing Specialist
1 day ago
Experience the fulfillment of overseeing credentialing and enrollment processes for healthcare providers in Maryland. This is a remote opportunity with our growing team, where you will play a pivotal role in ensuring compliance with state and federal regulations, as well as specific payer requirements.
Key Responsibilities:- Manage the credentialing and recredentialing processes for Maryland-based healthcare providers, including physicians, nurse practitioners, and allied health professionals.
- Ensure all provider files comply with Maryland state regulations, insurance guidelines, and national accreditation standards.
- Complete and submit credentialing applications and enrollment forms to commercial payers, Medicaid, and Medicare (via PECOS).
- Maintain and update provider data in credentialing systems such as CAQH, NPPES, and internal databases.
- Track and monitor expirable items such as licenses, certifications, and recredentialing deadlines.
- Communicate professionally with insurance companies, government agencies, and internal departments to resolve credentialing-related issues.
- Stay up to date with Maryland payer requirements, credentialing laws, and healthcare regulations.
- Conduct background checks, verify credentials, and maintain accurate, complete provider profiles.
- Prior experience in healthcare credentialing or provider enrollment, preferably with Maryland-based providers.
- Familiarity with Maryland-specific credentialing standards, including Maryland Medicaid and regional payers (e.g., CareFirst, Maryland Physicians Care).
- Proficiency with credentialing platforms such as CAQH, PECOS, and NPPES.
- Familiarity with the EPREP Portal (Maryland Emergency Preparedness and Response Portal), including provider registration and compliance functions.
- Exceptional attention to detail and the ability to manage multiple deadlines effectively.
- Strong written and verbal communication skills; professional in interactions with both internal and external stakeholders.
- Self-motivated and reliable in a fully remote work environment.
- Demonstrated commitment to confidentiality and compliance with healthcare regulations.
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