Certified Healthcare Validator

2 days ago

Cabuyao, Calabarzon, Philippines beBeeCredentialing Full time $50,000 - $80,000

We are seeking a seasoned Credentialing Specialist to join our team in overseeing the credentialing and enrollment processes for healthcare providers.

About the Role:
  • This is a unique opportunity to utilize your expertise in managing credentialing and recredentialing processes for physicians, nurse practitioners, and allied health professionals.
Key Responsibilities:
  • Manage Credentialing and Recredentialing Processes: Ensure provider files comply with state regulations, insurance guidelines, and national accreditation standards.
  • Complete and Submit Applications: Effectively complete and submit credentialing applications and enrollment forms to commercial payers, Medicaid, and Medicare via PECOS.
  • Maintain Provider Data: Maintain and update provider data in credentialing systems such as CAQH, NPPES, and internal databases.
  • Track Expirable Items: Monitor and track expirable items like licenses, certifications, and recredentialing deadlines.
  • Communicate Professionally: Communicate effectively with insurance companies, government agencies, and internal departments to resolve credentialing-related issues.
Requirements:
  • Prior Experience: Prior experience in healthcare credentialing or provider enrollment is essential, preferably with Maryland-based providers.
  • Familiarity with Maryland-Specific Credentialing Standards: Familiarity with Maryland-specific credentialing standards, including Maryland Medicaid and regional payers (e.g., CareFirst, Maryland Physicians Care).
  • Proficiency with Credentialing Platforms: Proficiency with credentialing platforms like CAQH, PECOS, and NPPES is necessary.
  • Familiarity with EPREP Portal: Familiarity with the EPREP Portal, including provider registration and compliance functions.
  • Exceptional Attention to Detail: Exceptional attention to detail and ability to manage multiple deadlines effectively.
  • Strong Written and Verbal Communication Skills: Strong written and verbal communication skills, professional in interactions with internal and external stakeholders.
  • Self-Motivated and Reliable: Self-motivated and reliable in a fully remote work environment.
  • Demonstrated Commitment to Confidentiality and Compliance: Demonstrated commitment to confidentiality and compliance with healthcare regulations.

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