CAQH Specialist

Physicians Practice Enhancement Llc; Red Bank (NJ); Remote; USD 52.000 - 72.000; Vollzeit

Zusammenfassung

Physicians Practice Enhancement Llc is seeking a CAQH Specialist to maintain provider profiles in the CAQH Provider Data Portal, supporting credentialing and payer enrollment. You will own provider records, resolve deficiencies, and coordinate with providers and internal teams to meet quality and turnaround SLAs.

Responsibilities include updating demographics, practice locations, licenses, and education; tracking attestations and document expirations; and safeguarding confidential information

Qualifikationen

• High school diploma or equivalent required.
• Data Entry Experience.
• 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.

Aufgaben

• Maintain CAQH profiles for assigned 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• Collect, verify, and upload required supporting documents; track expirations and resolve missing, inconsistent, or outdated information.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.

Kenntnisse

Data entry

Attention to detail

Organizational skills

Written communication

Remote collaboration tools

Ausbildung

High school diploma or equivalent

Associate degree preferred

Tools

Spreadsheets

Secure document systems

Remote work tools

Jobbeschreibung

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.