Multi-State Credentialing & Enrollment Specialist

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

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.