Managed Care Credentialing Specialist - remote

Hirebridge; Town of Texas (WI); Remote; USD 50,000 - 90,000; Full time

Job summary

An established industry player is seeking a Managed Care Credentialing Specialist for a fully remote role. This position involves supporting the end-to-end payor credentialing lifecycle, ensuring compliance with payor and regulatory standards. The ideal candidate will have a strong background in credentialing applications, excellent organizational skills, and the ability to manage multiple tasks efficiently. The company offers a supportive work environment with excellent benefits, including health insurance, a 401K plan, and growth opportunities. If you're passionate about improving lives through quality healthcare, this role is perfect for you.

Benefits

Health Insurance

Vision Insurance

Dental Insurance

Long-term Disability Insurance

Life Insurance

401K Plan with Employer Match

Vacation Package

Work-from-home Model

Growth Opportunities

Qualifications

• Experience in completing payor credentialing applications through various methods.
• Ability to interpret provider taxonomy, NPI, and other identifiers.

Responsibilities

• Coordinate payor credentialing activities for specialty pharmacies and infusion centers.
• Prepare and submit payor-specific credentialing applications.

Skills

Payor Credentialing

Data Tracking Systems

Organizational Skills

Customer Service

Microsoft Office Suite

Education

3 years’ experience in payor credentialing

Experience with NCPDP, NPPES, PECOS, CAQH

Tools

Salesforce

Contract Management Software

Job description

Managed Care Credentialing Specialist - remote

Please only apply if you have 2 or more years of experience in completing payor credentialing applications. This is a 100% remote opportunity.

AIS Healthcare is the leading provider of Targeted Drug Delivery (TDD) and Infusion Care. With our diverse culture and values around Innovation, Stewardship, and Unity, we are committed to advancing quality and improving lives. We are dedicated to doing more for our patients by providing quality products and services that enhance the entire care experience.

AIS Healthcare is seeking a Managed Care Specialist responsible for supporting the end-to-end payor credentialing lifecycle for a national network of specialty pharmacies and infusion centers. This includes coordinating credentialing and recredentialing processes, validating provider data, and ensuring documentation meets payor, regulatory, and accreditation standards. The role requires proficiency in credentialing platforms, data tracking systems, and cross-functional workflows to support contract execution, maintain active network status, and prevent service disruptions due to credentialing gaps.

We offer excellent benefits, including health, vision, and dental insurance; long-term disability insurance; life insurance; a vacation package; a 401K plan with a generous employer match; a hybrid office/work-from-home model; growth opportunities; and more. Additionally, this position is 100% remote.

Education and Experience:

• 3 years’ experience in completing payor credentialing applications through various methods.
• Experience with key websites/databases (e.g., NCPDP, NPPES, PECOS, CAQH).
• Experience managing multiple applications simultaneously and working efficiently to meet deadlines, preferably in home infusion, specialty pharmacy, and/or provider services.
• Ability to correctly interpret and utilize provider taxonomy, NPI, and other identifiers in payor credentialing applications.

Preferred Experience:

• Medicare and Medicaid enrollment and revalidation.
• Experience navigating contract management software is preferred.

Essential Duties and Responsibilities:

• Coordinate payor credentialing and recredentialing activities for specialty pharmacies, infusion centers, and clinical providers.
• Prepare and submit payor-specific credentialing applications, ensuring accuracy and adherence to deadlines.
• Maintain organized documentation for licenses, insurance, accreditations, and provider credentials.
• Serve as the primary contact with payor credentialing departments to resolve issues and ensure timely approvals.
• Track credentialing status and milestones within Salesforce; communicate updates to stakeholders.
• Maintain detailed records required by payors.
• Support patients' rights and confidentiality.
• Perform additional duties as assigned to support department goals.

Qualification Requirements:

• Self-motivated with goal-oriented mindset.
• Excellent organizational and time management skills.
• High attention to detail and accuracy.
• Customer-oriented approach for internal and external clients.
• Ability to handle multiple tasks in a fast-paced environment.
• Proficiency in Microsoft Office Suite.

Steps to Apply:

Complete the required Culture Index Candidate Assessment as part of your application. Applications without this step will not be considered.

Why does AIS utilize the Culture Index Assessment?

We recognize our employees' importance to our success. This assessment helps us match candidates to roles that utilize their natural traits and skills, fostering a strong team culture.

How to complete the assessment?

Follow the instructions provided in the application process. AIS Healthcare is a leading provider of advanced sterile, patient-specific intrathecal pump medications and in-home intravenous infusion services, including immune globulin therapies. We seek impact players who are positive, earnest, and hardworking.