Healthcare Credentialing Specialist

14 hours ago

Caloocan City, National Capital Region, Philippines beBeeCredentialing Full time $100,000 - $110,000
Job Title:

Credentialing Professional

Job Description:

We are seeking a skilled Credentialing Professional to join our team. In this role, you will oversee the credentialing and enrollment processes for healthcare providers practicing in Maryland. Your work will be essential in ensuring compliance with state and federal regulations, as well as specific payer requirements.

The ideal candidate will have 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), is also required.

  • Manage the credentialing and recredentialing processes for Maryland-based healthcare providers, including physicians, nurse practitioners, and allied health professionals.
  • Ensure all 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 such as 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.
Requirements:
  • 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.
  • 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.
Benefits:
  • Competitive salary and benefits package.
  • Ongoing training and development opportunities.
  • Collaborative and supportive work environment.

How to Apply: If you are a motivated and experienced Credentialing Professional, we would love to hear from you. Please submit your resume and cover letter for consideration.

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