Credentialing and Contracting Medical Provider Network (MPN) Specialist

TRISTAR MANAGED CARE INC; South Carolina; Remote; USD 45,000 - 60,000; 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 MANAGED CARE INC is seeking a Credentialing and Contracting Specialist responsible for managing contracts and credentialing databases. This full-time role involves tasks such as reviewing applications for accuracy and compliance, performing document verification, and maintaining provider files.

The ideal candidate will have strong communication skills, expertise in credentialing processes, and proficiency in Microsoft Office applications. Benefits include medical and dental insurance, 401(k) plans, and paid time off.

Qualifications

• Excellent written and oral communication skills.
• Strong customer service orientation.
• Proficiency in medical provider credentialing policies.
• Ability to manage confidential information.
• Advanced knowledge of Microsoft Office applications.

Responsibilities

• Review credentialing applications for completeness.
• Perform primary source verification of documents.
• Maintain provider contract files accurately.
• Monitor compliance with accreditation requirements.
• Enter and maintain data in the credentialing database.

Skills

Excellent written and oral communication skills

Strong customer service orientation

Proficiency in medical provider credentialing principles

Independent judgment

Advanced knowledge of Microsoft Word and Excel

Ability to learn new applications

Organized and able to prioritize 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