
Healthcare Credentialing Professional
1 day ago
Credentialing Specialist
Position Overview:Seeking a skilled credentialing professional with expertise in Maryland healthcare credentialing to oversee the credentialing and enrollment processes for healthcare providers practicing in Maryland.
The successful candidate will be responsible for 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.
- Verify all provider files comply with Maryland state regulations, insurance guidelines, and national accreditation standards.
- Prepare and submit credentialing applications and enrollment forms to commercial payers, Medicaid, and Medicare (via PECOS).
- Maintain accurate, complete provider data in credentialing systems such as CAQH, NPPES, and internal databases.
- Monitor and track expirable items such as licenses, certifications, and recredentialing deadlines.
- Communicate effectively 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 thorough background checks, verify credentials, and maintain provider profiles.
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Credentialing Specialist
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ABA Credentialing Professional
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Credentialing Specialist with 25 Night Differential
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Davao City, Davao, Philippines Connext Full time $70,000 - $120,000 per yearJob SummaryTheCredentialing Specialistis responsible for the timely and accurate enrollment and re-enrollment of healthcare clinicians with government and commercial insurance payors. The role ensures that all required documentation is submitted to payors to establish and maintain participation status and billing privileges, thereby supporting timely...