Healthcare Compliance Officer

19 hours ago

Baguio City, Cordillera, Philippines beBeeCredentialing Full time $70,000 - $85,000
Credentialing Specialist Role

Overseeing credentialing and enrollment processes for healthcare providers in Maryland is a vital function that ensures compliance with state and federal regulations, as well as specific payer requirements.

  • Manage the credentialing and recredentialing processes for Maryland-based healthcare providers.
  • Evaluate provider files to ensure they meet 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 like licenses, certifications, and recredentialing deadlines.
  • Communicate effectively with insurance companies, government agencies, and internal departments to resolve credentialing-related issues.
  • Stay informed about Maryland payer requirements, credentialing laws, and healthcare regulations.
  • Conduct background checks, verify credentials, and maintain accurate provider profiles.
Required Skills and Qualifications:
  • 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, including provider registration and compliance functions.
  • Strong attention to detail and effective deadline management.
  • Excellent written and verbal communication skills; professional in interactions with both internal and external stakeholders.
  • Self-motivated and reliable in a fully remote work environment.
  • Commitment to confidentiality and compliance with healthcare regulations.

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