Credentialing & Enrollment Specialist — Derm Network

QualDerm Partners LLC; United States; Remote; USD 48,000 - 65,000; Full time

Job summary

QualDerm Partners is seeking a Credentialing Specialist to oversee credentialing, re-credentialing and payer enrollment for an assigned region. You will develop relationships with regional leadership to ensure timely onboarding and complete credentialing before services are rendered under contracted plans.

Responsibilities include managing credentialing databases, ensuring license renewals, and coordinating data flow between payers and QualDerm networks, with a focus on quality and process

Qualifications

• Bachelor’s degree in related field preferred.
• Minimum of three years’ experience in managed care credentialing or medical staff service setting required.
• National or multi-state credentialing experience preferred.
• Demonstrated skills in analysis, problem solving and resolution.
• Ability to communicate appropriately and effectively with practitioners and providers, including sensitive and confidential information.
• Strong knowledge of NCQA, Joint Commission, URAC, CMS and State Laws and regulations as they pertain to credentialing of QualDerm providers.
• Prioritize and meet deadlines on an ongoing basis to ensure timely completion according to process requirements.
• Must be able to function independently in a matrix environment.

Responsibilities

• Oversee all aspects of Provider Credentialing and Payer Enrollment with third party payers and hospital / health system partners for assigned region.
• Assure compliance with all health plan requirements as related to provider certification and credentialing.
• Meets with assigned region operational leadership on a routine basis to ensure timely on-boarding of new providers and that all credentialing needs are met.
• Manages processes that maintain up-to-date data for each provider in credentialing databases and online systems.
• Ensures timely renewal of licenses, certifications, and credentialing.
• Maintains confidentiality of provider information.
• Assist in managing the flow of information between payers, contracted PHO’s, ACO’s and other QualDerm networks.
• Coordinate and prepare management reports for assigned regions.
• Manage continual process and quality improvement efforts related to payer enrollment, data entry, credentialing committees and all aspects related to credentialing & enrollment.
• Participates in the training of new Credentialing & Enrollment team members.

Skills

Analytical skills

Problem solving

Communication skills

Independent work

Deadline-driven

Education

Bachelor's degree

Job description

QualDerm Partners is seeking a Credentialing Specialist to oversee credentialing, re-credentialing and payer enrollment for an assigned region. You will develop relationships with regional leadership to ensure timely onboarding and complete credentialing before services are rendered under contracted plans.

Responsibilities include managing credentialing databases, ensuring license renewals, and coordinating data flow between payers and QualDerm networks, with a focus on quality and process