Healthcare Credentialing Professional

2 days ago

Cainta, Calabarzon, Philippines beBeeCredentialing Full time $100,000 - $123,456

Credentialing Specialist Role

This position entails overseeing the credentialing and enrollment processes for healthcare providers practicing in Maryland.

  • Manage the credentialing and recredentialing processes for 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 effectively 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.

Essential Skills and 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.
  • Proficiency with credentialing platforms such as CAQH, PECOS, and NPPES.
  • Familiarity with the EPREP 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 remote work environment.
  • Demonstrated commitment to confidentiality and compliance with healthcare regulations.

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