Credentialing & Payer Enrollment Specialist

QualDerm Partners; United States; On-site; USD 48,000 - 65,000; Full time

Benefits offered by this job

Competitive pay

Health coverage

401(k) plan

Paid time off

Life insurance

Disability protection

Wellness plans

EAP

Employee discounts

Referral bonuses

Job summary

QualDerm Partners is seeking a Credentialing Specialist to manage provider credentialing, payer enrollment, and privileging across our multi-state network. The role requires collaboration with regional leaders to ensure timely onboarding and compliant credentialing for providers in contracted and enrolled health plans.

The ideal candidate will have a bachelor’s degree, 3+ years in credentialing or medical staff services, and strong knowledge of NCQA, Joint Commission, URAC, CMS regulations, with

Qualifications

• Bachelor's degree in related field preferred.
• Minimum 3 years' experience in managed care credentialing or medical staff services.
• National or multi-state credentialing experience preferred.
• Strong analysis, problem-solving, and communication skills.
• Knowledge of NCQA, Joint Commission, URAC, CMS and state regulations as they pertain to credentialing.

Responsibilities

• Oversee Provider Credentialing and Payer Enrollment with third-party payers and hospital/health system partners for assigned region.
• Ensure compliance with health plan requirements related to credentialing and licensure.
• Meet with regional leadership to ensure timely provider onboarding and credentialing.
• Maintain up-to-date data in credentialing databases and online systems.
• Ensure timely renewal of licenses and certifications.
• Maintain confidentiality of provider information.
• Coordinate information flow between payers, PHOs, ACOs and QualDerm networks.
• Prepare management reports for assigned regions.
• Lead process and quality improvement efforts in credentialing and enrollment.
• Participate in training of new team members.

Skills

Bachelor's degree

Managed care credentialing

Payer enrollment

Multistate credentialing

Regulatory knowledge

Communication skills

Education

Bachelor's degree

Tools

NCQA Knowledge

Joint Commission

URAC

CMS regulations

Job description

QualDerm Partners is seeking a Credentialing Specialist to manage provider credentialing, payer enrollment, and privileging across our multi-state network. The role requires collaboration with regional leaders to ensure timely onboarding and compliant credentialing for providers in contracted and enrolled health plans.

The ideal candidate will have a bachelor’s degree, 3+ years in credentialing or medical staff services, and strong knowledge of NCQA, Joint Commission, URAC, CMS regulations, with