Senior Healthcare Credentialing Specialist

Cxcentrodecontacto; Monterrey; Presencial; MXN 360.000 - 480.000; Jornada completa

Descripción de la vacante

One Call in Monterrey, Mexico is seeking a Senior Credentialing Specialist to support credentialing and recredentialing for healthcare providers and ensure network compliance with quality and regulatory standards. The role emphasizes meticulous documentation and adherence to timelines.

The ideal candidate has 5+ years in credentialing, experience with PSV, and knowledge of NCQA, URAC, CMS requirements, with strong English communication and Excel proficiency.

Formación

• 5+ years in provider credentialing, healthcare enrollment, medical staff services, or related healthcare function.
• Strong experience with initial credentialing and recredentialing.
• Knowledge of PSV, licensing, certifications, registrations, and professional liability insurance.
• Knowledge of healthcare accreditation and regulatory standards such as NCQA, URAC, CMS, and state/federal requirements.
• Experience with credentialing audits, compliance reviews, or accreditation activities.
• Experience with credentialing databases and healthcare information systems.
• Salesforce experience is a plus.

Responsabilidades

• Manage initial credentialing and recredentialing applications for healthcare providers.
• Review provider applications and documentation for completeness, accuracy, and compliance.
• Conduct and document Primary Source Verification of provider credentials.
• Verify licenses, certifications, registrations, professional liability insurance, and other required credentials.
• Monitor credential expirations and initiate renewals and recredentialing activities.
• Maintain accurate provider credentialing records and electronic files.
• Track application status, deadlines, turnaround times, and service-level expectations.
• Support credentialing audits, regulatory reviews, accreditation activities, and special projects.
• Monitor compliance with credentialing policies and regulatory requirements.

Conocimientos

Attention to detail

Communication skills

Time management

Analytical thinking

Independent judgment

Problem solving

Organizational skills

English proficiency

Educación

High school diploma or equivalent

Associates degree or coursework in Healthcare Administration/Business/Medical Administration

CPCS certification or equivalent credentialing certification

Herramientas

Salesforce

Microsoft Excel

Microsoft Word

PowerPoint

Descripción del empleo

One Call in Monterrey, Mexico is seeking a Senior Credentialing Specialist to support credentialing and recredentialing for healthcare providers and ensure network compliance with quality and regulatory standards. The role emphasizes meticulous documentation and adherence to timelines.

The ideal candidate has 5+ years in credentialing, experience with PSV, and knowledge of NCQA, URAC, CMS requirements, with strong English communication and Excel proficiency.