CAQH Specialist

Physicians-Practice-Enhancement-LL; Red Bank (NJ); À distance; USD 55 000 - 75 000; Plein temps

Résumé du poste

ProCred is seeking a CAQH Specialist to maintain provider profiles in the CAQH Provider Data Portal, ensuring accuracy for credentialing and payer enrollment. You will own provider records, resolve deficiencies, coordinate with providers and teams, and meet SLA-driven quality targets.

Responsibilities include data collection, document verification, discrepancy resolution, and proactive status reporting, with a focus on confidentiality and remote collaboration.

Qualifications

• High school diploma or equivalent required; associate degree or relevant training preferred.
• Data entry experience required.
• Strong attention to detail and organizational skills.
• Comfort with spreadsheets, shared work queues, secure document systems, and remote collaboration tools.
• Ability to manage a high-volume assigned portfolio with minimal supervision.

Responsabilités

• Create, update, and maintain CAQH profiles for assigned healthcare providers, including demographics, practice locations, education, training, licenses, certifications, insurance, and work history.
• Monitor attestation and reattestation requirements; coordinate provider review and authorization and complete permitted actions within established deadlines.
• Collect, verify, and upload required supporting documents; track expirations and resolve missing, inconsistent, or outdated information.
• Identify discrepancies between CAQH, internal credentialing systems, and payer enrollment records; escalate material mismatches.
• Communicate professionally with providers, practice contacts, and credentialing/enrollment colleagues to obtain outstanding items.
• Document work performed, follow-up attempts, barriers, and completion dates in designated systems; maintain reliable status reporting.
• Prioritize urgent provider starts, payer deadlines, expiring credentials, and overdue tasks according to department SLAs.
• Protect confidential provider information and follow company security, privacy, access-control, and approved remote-work procedures.
• Participate in quality audits, process improvement, and cross-training as assigned.

Connaissances

Data Entry Experience

Attention to detail

Organizational skills

Written communication

Remote collaboration tools

High-volume portfolio management

Formation

High school diploma or equivalent

Associate degree or relevant training preferred

Outils

Spreadsheets

Secure document systems

Description du poste

The CAQH Specialist maintains complete, accurate, and current provider profiles in the CAQH Provider Data Portal to support timely credentialing and payer enrollment. This role owns assigned provider records, proactively resolves deficiencies, coordinates with providers and internal teams, and meets defined quality and turnaround expectations.

• Create, update, and maintain CAQH profiles for assigned healthcare providers, including demographics, practice locations, education, training, licenses, certifications, insurance, and work history.
• Monitor attestation and reattestation requirements; coordinate provider review and authorization and complete permitted actions within established deadlines.
• Collect, verify, and upload required supporting documents; track expirations and resolve missing, inconsistent, or outdated information.
• Identify discrepancies between CAQH, internal credentialing systems, and payer enrollment records; escalate material mismatches.
• Communicate professionally with providers, practice contacts, and credentialing/enrollment colleagues to obtain outstanding items.
• Document work performed, follow-up attempts, barriers, and completion dates in designated systems; maintain reliable status reporting.
• Prioritize urgent provider starts, payer deadlines, expiring credentials, and overdue tasks according to department SLAs.
• Protect confidential provider information and follow company security, privacy, access-control, and approved remote-work procedures.
• Participate in quality audits, process improvement, and cross-training as assigned.

Qualifications

• High school diploma or equivalent required; associate degree or relevant training preferred.
• Data Entry Experience
• Strong attention to detail, organizational skills, follow-through, and written communication.
• Comfort with spreadsheets, shared work queues, secure document systems, and remote collaboration tools.
• Ability to manage a high-volume assigned portfolio with minimal supervision.

Performance Expectations

Performance will be assessed through profile accuracy, timely attestations, document completeness, work-queue aging, productivity, provider responsiveness, and adherence to assigned SLAs. Specific numeric targets will be set by department leadership.

Working Conditions & Equal Opportunity

Remote computer-based work with routine video/telephone collaboration. ProCred is committed to equal employment opportunity and considers qualified applicants without regard to legally protected characteristics. Reasonable accommodations are available in accordance with applicable law.