MD Healthcare Credentialing Expert

21 hours ago

General Santos, Soccsksargen, Philippines beBeeCredentialing Full time $80,000 - $100,000
Healthcare Credentialing Professional

We are seeking a highly skilled and detail-oriented Credentialing Specialist to oversee the credentialing and enrollment processes for healthcare providers practicing in Maryland.

  • 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.

Key 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.
  • 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.
  • Demonstrated commitment to confidentiality and compliance with healthcare regulations.

Responsibilities Include:

  • Background checks and verification of credentials.
  • Maintenance of accurate and complete provider profiles.
  • Collaboration with various departments and entities to ensure seamless credentialing processes.

Benefits:

This role offers a unique opportunity to make a meaningful impact on the healthcare landscape. As a Credentialing Specialist, you will have the chance to work closely with healthcare providers and organizations, ensuring that they meet the necessary standards for quality care.

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