Healthcare Provider Credentialing Specialist
7 days ago
This is a remote position that involves overseeing the credentialing and enrollment processes for healthcare providers practicing in Maryland. The successful candidate will be responsible for ensuring compliance with state and federal regulations, as well as specific payer requirements.
Key Responsibilities:- Manage the credentialing and recredentialing processes for Maryland-based healthcare providers.
- 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.
- 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.
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