Credentialing Specialist

ElevateCalls; Manila; A distancia; PHP 3.781.000 - 5.356.000; Jornada completa

Descripción de la vacante

Elevate Calls Inc. is seeking a Credentialing Specialist with Maryland healthcare credentialing experience to join a growing remote team.

You will oversee credentialing and enrollment for Maryland-based providers and ensure compliance with state and payer requirements. Key duties include managing credentialing and recredentialing, submitting enrollment forms to Medicaid and Medicare via PECOS, and maintaining provider data in CAQH, NPPES, and internal systems.

Formación

• Healthcare credentialing experience
• Maryland credentialing standards familiarity
• Proficiency with CAQH, PECOS, NPPES

Responsabilidades

• Manage credentialing and recredentialing for Maryland-based providers.
• Ensure files comply with Maryland regulations and payer guidelines.
• Submit enrollment forms to commercial payers, Medicaid, and Medicare (PECOS).
• Maintain provider data in CAQH, NPPES, and internal systems.
• Track license and certification expirations and deadlines.
• Communicate with insurers, government agencies, and internal teams to resolve issues.
• Stay updated on Maryland payer requirements and healthcare regulations.
• Conduct background checks and verify credentials for provider profiles.

Descripción del empleo

Job Title: Credentialing Specialist Maryland Healthcare Providers

Company: Elevate Calls Inc.

Location: Remote (Permanent Work From Home Position)

Position Overview

Elevate Calls Inc. is seeking a Credentialing Specialist with experience in Maryland healthcare credentialing to join our growing remote team. In this role, you will oversee the credentialing and enrollment processes for healthcare providers practicing in Maryland. Your work will be essential in 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, 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.
• Stay up to date with Maryland payer requirements, credentialing laws, and healthcare regulations.
• Conduct background checks, verify credentials, and maintain accurate, complete provider profiles.

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.
• 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.

Industry

• Business Consulting and Services

Employment Type

Full-time