Healthcare Credentialing Professional
19 hours ago
This position involves leading the credentialing and enrollment processes for healthcare providers practicing in Maryland. Ensuring adherence to state and federal regulations, as well as specific payer requirements, is essential.
- Oversee credentialing and recredentialing processes for Maryland-based healthcare providers.
- Ensure 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 like 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 and proficiency with credentialing platforms like CAQH, PECOS, and NPPES.
We are seeking a motivated credentialing professional who can work effectively in a remote environment and demonstrate commitment to confidentiality and compliance with healthcare regulations.
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