Credentialing Specialist - Remote

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

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

Requirements

• 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

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.