Healthcare Credentialing Expert

2 weeks ago

Imus, Calabarzon, Philippines beBeeCredentialing Full time $50,000 - $80,000
Credentialing Specialist Job Description

Elevate Calls Inc. is a remote-based company seeking a skilled Credentialing Specialist to join our team.

The ideal candidate will have experience in Maryland healthcare credentialing and be proficient in managing the credentialing and recredentialing processes for healthcare providers practicing in Maryland.

Key responsibilities include ensuring all provider files comply with Maryland state regulations, insurance guidelines, and national accreditation standards, as well as completing and submitting credentialing applications and enrollment forms to commercial payers, Medicaid, and Medicare (via PECOS).

The successful candidate will also 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, and communicate professionally with insurance companies, government agencies, and internal departments to resolve credentialing-related issues.

The ideal candidate will have 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, proficiency with credentialing platforms such as CAQH, PECOS, and NPPES, and exceptional attention to detail and the ability to manage multiple deadlines effectively.

  • Manage the credentialing and recredentialing processes for Maryland-based healthcare providers.
  • 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.

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