Credentialing Specialist - Remote

Qualderm; Northern (KY); Hybrid; USD 48,000 - 65,000; Full time

Benefits offered by this job

Competitive Pay

Comprehensive Health Coverage

Generous 401(k) Plan

Paid Time Off (PTO)

Company-Paid Life Insurance

Disability Protection

Additional Wellness Plans

Employee Assistance Program (EAP)

Exclusive Employee Discounts

Referral Bonus Program

Job summary

QualDerm Partners is seeking a Credentialing Specialist to oversee credentialing, re-credentialing, payer enrollment and privileging for providers across a broad regional footprint. Reporting to the Senior Director, you will build strong relationships with regional leaders to ensure timely onboarding and compliance with health plan requirements.

The role emphasizes data integrity, process standardization, and collaboration with payers, PHOs and ACOs.

Qualifications

• Bachelor’s degree preferred.
• Minimum of three (3) years’ experience in managed care credentialing or medical staff service setting.
• 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.
• Prioritize and meet deadlines to ensure timely completion per process requirements.
• Ability 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 health plan requirements related to provider certification and credentialing.
• Meet with regional leadership to ensure timely onboarding of new providers and credentialing needs.
• Maintain up-to-date data for each provider in credentialing databases and online systems.
• Ensure timely renewal of licenses, certifications, and credentialing.
• Maintain confidentiality of provider information.
• Assist in managing flow of information between payers, contracted PHOs, ACOs and other QualDerm networks.
• Coordinate and prepare management reports for assigned regions.
• Manage continuous process and quality improvement efforts related to payer enrollment and credentialing.

Skills

Analysis

Problem solving

Communication

Independent work

Regulatory knowledge

Education

Bachelor’s degree in related field

Job description

With 150+ locations in 17 states, QualDerm Partners is the largest multi-state female-founded and owned dermatology network in the U.S. At QualDerm Partners, we are united in our purpose: to educate, protect, and care for your skin. We are committed to bringing you the very best in comprehensive skin care so that you can achieve a confident, healthier, and more beautiful you!

Our mission is to educate communities and healthcare professionals about the importance of skin health; including skin cancer prevention, risk factors and how to achieve healthy skin through annual skin exams and dermatologic care. We strive to provide the latest proven, proactive and comprehensive dermatologic care to populations in the expanding geographies we serve by making high-quality skin care timelier and more accessible all while creating a rewarding work environment for our providers and employees.

Purpose:

Reporting to the Senior Director, Credentialing and Revenue Cycle, the Credentialing Specialist is responsible for overseeing all aspects of the credentialing, re-credentialing, payer enrollment and privileging processes for all providers in an assigned region. The Credentialing Specialist will develop strong relationships with regional operational leaders to ensure proactive communication on credentialing and recredentialing requirements while ensuring that credentialing is complete in advance of services being rendered under contracted and enrolled health plans. The Credentialing Specialist will be responsible for implementing standardized processes and capturing data for each provider in QualDerm's credentialing databases and online systems for utilization across multiple stakeholder groups.

Essential Duties and 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.

• Bachelor’s degree in related field preferred.
• Minimum of three (3) 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 the 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.

Benefits of joining Qualderm Partners:

• Competitive Pay – Attractive compensation to reward your hard work
• Comprehensive Health Coverage – Includes Medical, Dental, and Vision plans to keep you covered
• Generous 401(k) Plan – Company matches 100% of the first 3%, plus 50% of the next 2%, with immediate vesting
• Paid Time Off (PTO) – Accrue PTO from day one, plus enjoy 6 paid holidays and 2 floating holidays each year
• Company-Paid Life Insurance – Peace of mind with basic life coverage, with the option for additional plans
• Disability Protection – Short-term and long-term disability coverage to protect you in unexpected circumstances
• Additional Wellness Plans – Accident, critical illness, and identity theft protection plans for extra security
• Employee Assistance Program (EAP) – Access confidential support for personal or work-related challenges
• Exclusive Employee Discounts – Save on products and services with special discounts just for you
• Referral Bonus Program – Earn bonuses by referring qualified candidates to join the team

QualDerm Partners is proud to be an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. Applicants must be currently authorized to work in the United States in a full-time basis.

Compensation Range: $48,152 - $64,916 per year. Final offer will be based on a combination of skills, experience, location, and internal equity.