Payor Credentialing Specialist

Wheeler Staffing Partners; Dallas (TX); Presencial; USD 85 962 000 - 94 558 000; Tempo integral

Resumo da oferta

Wheeler Staffing Partners seeks an experienced Credentialing Specialist for a contract opportunity in Dallas, TX. This onsite role focuses on provider credentialing, enrollment, and database management to support compliance and timely onboarding.

The position offers a Monday–Friday schedule, 8:00 AM–5:00 PM, with pay at $30–$33 per hour and potential to convert to permanent employment.

Qualificações

• Minimum 4 years in managed care, centralized credentialing, or related healthcare environment.
• Knowledge of health plan credentialing and payer enrollment requirements (Medicare/Medicaid).
• Experience with CAQH applications and credentialing workflows.
• Familiarity with contract language interpretation and administration.
• Strong proficiency in Excel; Microsoft 365 tools; credentialing databases; Salesforce a plus.

Responsabilidades

• Collaborate with the local market onboarding team on all new providers in the pipeline.
• Request credentialing data and supporting documents from physicians; communicate delays impacting timelines.
• Prepare and update CAQH applications for initial credentialing and recredentialing.
• Build and maintain relationships with market and national health plans.
• Communicate newly affiliated providers to plans for TIN changes and demographic updates.
• Establish credentialing status to facilitate billing across specialties.
• Maintain credentialing databases and ensure accurate tracking of files.

Conhecimentos

Managed care experience

CAQH applications

Credentialing workflows

Microsoft Excel

Microsoft 365

Formação académica

High School Diploma

Vocational/technical training

Ferramentas

CAQH applications

Credentialing databases

Salesforce

Descrição da oferta de emprego

Work Arrangement: 100% Onsite – Not Remote

Schedule: Monday – Friday, 8:00 AM – 5:00 PM

Pay Rate: $30 – $33 per hour

About the Role

Wheeler Staffing Partners is seeking an experienced Credentialing Specialist for a contract opportunity with the potential to convert to a permanent role. This role will be fully onsite in Dallas, TX, and will focus on provider credentialing, enrollment, and database management to support compliance and ensure timely provider onboarding.

Key Responsibilities

• Collaborate with the local market onboarding team on all new providers in the pipeline.
• Request credentialing data and supporting documents from physicians; communicate delays that may impact project timelines.
• Prepare and update providers’ CAQH applications for initial credentialing and recredentialing.
• Build and maintain peer-to-peer relationships with relevant market and national health plans.
• Communicate newly affiliated providers to plans for TIN changes, demographic updates, or credentialing initiation.
• Establish credentialed status to facilitate billing across multiple specialties.
• Maintain and update credentialing databases to ensure accurate tracking of files and processes.
• Execute all standard operating procedures (SOPs) and communicate issues, trends, and concerns to the Regional Supervisor.
• Identify opportunities for process improvement and work with leadership to streamline workflows.
• Ensure workflow items are completed within required turnaround times while meeting quality standards.
• Resolve issues related to billing and collections; educate internal markets on contractual obligations and payor requirements.
• Provide credentialing information to Market Operations to support practice management.
• Maintain knowledge of NCQA standards, delegated credentialing, and Primary Source Verification.

Qualifications

• Minimum of 4 years of experience in managed care, a centralized credentialing office, or a related healthcare environment (credentialing or file maintenance).
• Knowledge of health plan credentialing, governmental payer enrollment (Medicare and Medicaid, multi-state), and related requirements.
• Experience with CAQH applications and credentialing workflows.
• Familiarity with contract language interpretation and administration.
• Strong skills in Microsoft Excel (required), Microsoft 365 (Word, PowerPoint, Outlook), and credentialing databases. Salesforce experience is a plus.
• Proven ability to work within deadline-driven environments.
• Excellent communication, problem-solving, and customer service skills.
• High School Diploma required; vocational or technical training preferred.

Preferred Skills

• Roster management and reporting experience.
• Experience navigating government portals for Medicare and Medicaid enrollment.
• Strong attention to detail, organizational skills, and ability to manage confidential information.