Healthcare Credentialing Expert

2 days ago

Pasig, National Capital Region, Philippines beBeeCredentialing Full time $74,000 - $88,000

Elevate your career with a challenging and rewarding role as a Credentialing Specialist. We are seeking a skilled professional to oversee the credentialing and enrollment processes for healthcare providers practicing in Maryland.

  • This is an excellent opportunity to join our team and work from home, leveraging your expertise in Maryland healthcare credentialing to ensure compliance with state and federal regulations.

  • You will be responsible for managing the credentialing and recredentialing processes, ensuring all provider files comply with Maryland state regulations, insurance guidelines, and national accreditation standards.

Key responsibilities include:

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

  • Ensuring all provider files comply with Maryland state regulations, insurance guidelines, and national accreditation standards.

  • Completing and submitting credentialing applications and enrollment forms to commercial payers, Medicaid, and Medicare (via PECOS).

  • Maintaining and updating provider data in credentialing systems such as CAQH, NPPES, and internal databases.

  • Tracking and monitoring expirable items such as licenses, certifications, and recredentialing deadlines.

  • Communicating professionally with insurance companies, government agencies, and internal departments to resolve credentialing-related issues.

  • Staying up to date with Maryland payer requirements, credentialing laws, and healthcare regulations.

  • Conducting background checks, verifying credentials, and maintaining accurate, complete provider profiles.

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 (e.g., CareFirst, Maryland Physicians Care).

  • Proficiency with credentialing platforms such as CAQH, PECOS, and NPPES.

  • Familiarity with the EPREP Portal (Maryland Emergency Preparedness and Response Portal), including provider registration and compliance functions.

  • Exceptional attention to detail and the ability to manage multiple deadlines effectively.

  • Strong written and verbal communication skills; professional in interactions with both internal and external stakeholders.

  • Self-motivated and reliable in a fully remote work environment.

  • Demonstrated commitment to confidentiality and compliance with healthcare regulations.

To apply for this exciting opportunity, please submit your resume to the designated contact. We look forward to reviewing your application and discussing how you can contribute to our team's success.

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