Credentialing Specialist Position

2 days ago

Las Piñas, National Capital Region, Philippines beBeeCredentialing Full time $56,820 - $75,530
Credentialing Specialist

We are seeking a highly skilled Credentialing Specialist to oversee the credentialing and enrollment processes for healthcare providers practicing in Maryland. In this role, you will ensure 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.
  • Evaluate provider files for compliance with Maryland state regulations, insurance guidelines, and national accreditation standards.
  • 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.
Qualifications:
  • 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.
  • Familiarity with the EPREP Portal including provider registration and compliance functions.
  • Strong analytical and problem-solving skills with attention to detail.
  • Excellent communication and interpersonal skills.

This is an exciting opportunity to join our team and contribute your expertise in healthcare credentialing. If you have a passion for ensuring seamless patient care and compliance, we encourage you to apply.

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