Credentialing and Contracting Medical Provider Network (MPN) Specialist

Tristar Insurance; South Carolina; Hybrid; USD 40,000 - 55,000; Full time

Benefits offered by this job

Medical, Dental, Vision Insurance

Life & Disability Insurance

Paid time off and paid holidays

401(k) plan

Referral bonus

Job summary

Tristar Insurance is looking for a Credentialing and Contracting Specialist to join their team. This role focuses on preparing and maintaining contracts, managing credentialing applications, and ensuring compliance with state regulations.

The ideal candidate should have excellent communication skills, a strong customer service orientation, and proficiency in credentialing processes. The position offers benefits like medical, dental, vision insurance, and a 401(k) plan.

Qualifications

• Excellent written and oral communication skills.
• Strong customer service orientation and timely email response.
• Experience with Outlook, Word, Excel and credentialing documentation.

Responsibilities

• Review and screen credentialing applications for accuracy and compliance.
• Perform primary source verification and validate crucial documents.
• Maintain provider contract files and resolve discrepancies.
• Monitor file completeness and accuracy for accreditation.

Skills

Excellent written and oral communication skills

Strong customer service orientation

Proficiency in medical provider credentialing

Independent judgment and managing confidential information

Advanced knowledge of Microsoft Word and Excel

Ability to prioritize multiple tasks

Education

High school diploma or equivalent

Tools

Microsoft Word

Microsoft Excel

Outlook

Job description

Credentialing and Contracting Specialist

Job Details

Location: Remote (prefer candidates in Texas).Job Type: Full Time, Entry Level.Category: Admin – Clerical.

Job Summary

The Credentialing and Contracting Specialist is responsible for preparing and maintaining contracts and the contracts database system. This role maintains active status for all providers by completing initial and subsequent credentialing packages in compliance with state regulations, guidelines and policies.

Responsibilities

• Review and screen credentialing applications for completeness, accuracy, and compliance.
• Perform primary source verification and validate documents such as state licenses, DEA certificates and malpractice coverage.
• Maintain provider contract files and resolve discrepancies, time gaps and other issues that impact credentialing.
• Monitor file completeness and accuracy, ensuring compliance with accreditation requirements and internal policies.
• Enter, update and maintain data in the credentialing database, ensuring accuracy and proper field use.
• Coordinate electronic verification requests and track responses to meet established timelines.
• Participate in process improvement initiatives for the credentialing workflow.
• Communicate clearly with providers, liaisons and staff to address day‑to‑day credentialing and provider issues.
• Assist in locating physicians for network staffing when needed.
• Maintain professional growth through industry affiliations and continuous learning about healthcare regulations.
• Perform miscellaneous job‑related duties as assigned.

Qualifications

• Excellent written and oral communication skills.
• Strong customer service orientation and timely email response.
• Proficiency in medical provider credentialing and accreditation principles, policies and documentation.
• Independent judgment and ability to manage confidential information.
• Advanced knowledge of Microsoft Word and Excel.
• Experience with Outlook, Word, Excel and other databases.
• Ability to learn new applications for remote work efficiency.
• Organized, able to prioritize multiple tasks and manage time effectively.
• High school diploma or equivalent required; GED acceptable.

Benefits

• Medical, Dental, Vision Insurance
• Life & Disability Insurance
• Paid time off and paid holidays
• 401(k) plan
• Referral bonus