Credentialing Specialist

Medix; United States; Remote; USD 60,000 - 90,000; Full time

Job summary

Medix is seeking a Provider Credentialing Specialist to support core credentialing and recredentialing operations for health plan networks. This role focuses on primary source verification, data integrity, and compliance with NCQA, NPDB, and CMS guidelines.

The position is 100% remote on a contract basis, with equipment provided. Responsibilities include data management, verification tracking, committee support, and maintaining HIPAA confidentiality, serving as a liaison with IPAs and

Qualifications

• Minimum of 1 year of hands-on experience processing provider credentialing applications.
• Proficiency in database management, word processing, and spreadsheets.
• Strong organizational, written and verbal communication, and ability to work independently in a remote environment.

Responsibilities

• Data management, entry, and maintenance of practitioner data in health plan databases and storage systems (e.g., OnBase).
• Perform primary source verifications and investigations with regulatory bodies and boards.
• Maintain knowledge of NCQA, NPDB, and CMS guidelines and compliance.
• Handle high-volume inquiries via email and phone, liaising between organization, IPAs, delegates, and practitioner offices.
• Review monthly recredentialing reports to meet deadlines.
• Prepare written summaries/reports for the Credentialing Committee meetings.
• Maintain strict HIPAA compliance and confidentiality of all practitioner records.

Skills

Data management

Word processing

Spreadsheets

Organizational skills

Communication

Education

Associate degree preferred

NAMSS CPCS certification (a plus)

Job description

Job Description

We are seeking a Provider Credentialing Specialist to join our team in supporting core credentialing and recredentialing operations for health plan network providers. This role focuses on primary source verification, data integrity, and compliance with industry standards to ensure high-quality care for members.

This is a 100% Remote, contract opportunity with all necessary computer equipment provided.

Key Responsibilities

• Data Management & Entry: Input, update, and maintain accurate practitioner data within the health plan's computer database and storage systems (e.g., OnBase).
• Primary Source Verification: Conduct thorough background checks and primary source verifications, including investigations, requests, and tracking responses from regulatory sources, state medical boards, and accrediting bodies.
• Compliance & Regulations: Maintain a strong working knowledge of National Committee for Quality Assurance (NCQA) standards, National Practitioner Data Bank (NPDB) requirements, and Centers for Medicare & Medicaid Services (CMS) guidelines.
• Communication & Customer Service: Handle high-volume internal and external inquiries via email and phone, serving as a liaison between the organization, IPAs, delegates, and practitioner offices.
• Recredentialing Tracking: Review monthly reports to ensure all assigned health professionals complete recredentialing by targeted deadlines.
• Committee Support: Assist in preparing written summaries and reports regarding adverse actions for the monthly Credentialing Committee meetings.
• Confidentiality: Maintain strict compliance with HIPAA laws, privacy policies, and the confidential handling of all practitioner records.

Qualifications & Requirements

Required Skills & Experience

• Experience: Minimum of 1 year of hands‑on experience processing provider credentialing applications.
• Technical Skills: Proficiency in database management, word processing, and spreadsheets.
• Soft Skills: Strong organizational skills, clear written and verbal communication, and the ability to work independently in a remote environment.

Preferred Skills & Credentials

• Payer‑Side Experience: Prior experience processing credentialing within a health insurance, health plan, or payer setting.
• Regulatory Standards: Strong working knowledge of NCQA standards and state/federal regulatory guidelines.
• Education/Certification: Associate Degree preferred. NAMSS Certified Provider Credentialing Specialist (CPCS) certification is a plus.

Work Schedule & Environment

• Work Modality: Fully Remote (Equipment provided by client).
• Training Schedule: 8:00 AM - 5:00 PM PST (Monday - Friday) for the first 2-3 weeks.
• Post-Training Schedule: Flexible start/end times between 5:00 AM - 5:00 PM PST.

For California Applicants

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.

Company Description

Here at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine.

Our commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, bu