Credentialing Specialist

NPB Consultants; United States; Remote; USD 50,000 - 70,000; Full time

Job summary

NPB Consultants is seeking a Credentialing Specialist to manage the credentialing processes for healthcare professionals. The ideal candidate will have strong attention to detail, excellent communication skills, and a solid understanding of credentialing regulations. This role combines compliance management with collaboration across departments, ensuring that credentialing workflows are seamless and efficient.

Qualifications

• Minimum 2 years of experience in healthcare credentialing or related role.
• Familiarity with credentialing software is a plus.
• Certification as a Credentialing Specialist preferred or willingness to obtain.

Responsibilities

• Manage credentialing and recredentialing processes for healthcare professionals.
• Ensure compliance with federal, state, and organizational regulations.
• Conduct primary source verifications and maintain provider databases.

Skills

Attention to detail

Organizational skills

Communication

Problem-solving

Education

High school diploma or equivalent

Associate's or Bachelor's degree in healthcare administration, business, or a related field

Tools

Credentialing software (e.g., IntelliCred, VeriDoc)

Job description

Job Summary:

We are seeking a meticulous and detail-oriented Credentialing Specialist to join our team. In this role, you will be responsible for managing the credentialing and recredentialing process for healthcare professionals to ensure compliance with regulatory standards, organizational policies, and industry best practices. The ideal candidate will have a strong understanding of credentialing procedures, excellent communication skills, and a proactive approach to resolving issues.

Key Responsibilities:

Credentialing and Recredentialing:

Review, process, and maintain credentials for healthcare providers, ensuring accuracy and completeness of all required documentation, including licenses, certifications, and education records.

Compliance Management:

Ensure all credentialing processes comply with federal, state, and organizational regulations, including Medicare, Medicaid, and other payer requirements.

Database Management:

Maintain and update provider databases, ensuring all information is accurate and up to date. Utilize credentialing software and tools to manage provider records.

Primary Source Verification:

Conduct primary source verifications of licenses, certifications, education, and training to confirm the qualifications and professional standing of healthcare providers.

Communication with Providers:

Serve as the primary point of contact for healthcare providers regarding credentialing status, requests for additional documentation, and updates.

Reporting and Documentation:

Prepare and generate reports for management and regulatory bodies as needed. Document all credentialing activities in compliance with internal policies and external regulations.

Collaboration with Departments:

Work closely with the HR, Compliance, and Medical Affairs departments to ensure seamless credentialing workflows and to address any issues promptly.

Ongoing Education:

Stay informed about changes in credentialing regulations, payer requirements, and industry best practices to ensure ongoing compliance and efficiency.

Required Qualifications:

Education:

High school diploma or equivalent required. Associate's or Bachelor's degree in healthcare administration, business, or a related field preferred.

Experience:

Minimum of 2 years of experience in healthcare credentialing or a related administrative role. Familiarity with credentialing software and healthcare systems is a plus.

Knowledge:

Understanding of credentialing guidelines, including federal, state, and payer-specific requirements. Strong knowledge of healthcare regulations and policies related to credentialing.

Skills:

Excellent attention to detail and organizational skills. Strong written and verbal communication skills. Ability to manage multiple priorities and meet deadlines.

Certifications:

Certification as a Credentialing Specialist (CPCS) from the National Association Medical Staff Services (NAMSS) is preferred or willingness to obtain within a set timeframe.

Preferred Qualifications:

Experience with healthcare management software (e.g., IntelliCred, VeriDoc).

Previous experience working in a hospital, medical group, or other healthcare settings.

Physical Requirements:

Prolonged periods sitting at a desk and working on a computer.

Ability to occasionally lift up to 15 pounds.

Working Conditions:

Typical office environment with the possibility of remote work based on organizational policies.

Occasional evening or weekend work may be required.

NPB Consultants Pvt. Ltd. is an equal opportunity employer and values diversity. All employment is decided based on qualifications, merit, and business need. We are committed to creating an inclusive environment for all employees.