Regional Credentialing & Enrollment Specialist

QualDerm Partners, LLC; United States; Remote; USD 48,000 - 65,000; Full time

Benefits offered by this job

Competitive Pay

Comprehensive Health Coverage

Generous 401(k)

Paid Time Off

Company-Paid Life Insurance

Disability Protection

Wellness Plans

Employee Assistance Program

Exclusive Discounts

Referral Bonus Program

Job summary

QualDerm Partners is seeking a Credentialing Specialist to oversee provider credentialing, payer enrollment, and privileging across regions, ensuring timely on-boarding and compliance with NCQA, Joint Commission, URAC, CMS rules.

Reporting to the Senior Director, Credentialing and Revenue Cycle, you will maintain data integrity in credentialing databases, collaborate with payers and health systems, train new staff, and support regional leadership.

Qualifications

• Oversee provider credentialing and payer enrollment with payers and partners in the region.
• Assure compliance with all health plan requirements as related to provider certification and credentialing.
• Meets with regional leadership to ensure timely on-boarding of new providers and credentialing needs.
• Maintains up-to-date data for each provider in credentialing databases.
• Ensures timely renewal of licenses, certifications, and credentialing.
• Maintains confidentiality of provider information.
• Assist in managing information flow between payers, contracted PHO’s, ACO’s and QualDerm networks.
• Coordinate and prepare management reports for assigned regions.
• Manage continual process and quality improvement efforts related to enrollment and credentialing.
• Participates in training of new Credentialing & Enrollment team members.

Responsibilities

• 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 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.

Skills

Analytical skills

Problem solving

Communication

Independence

Credentialing knowledge

Education

Bachelor's degree

Job description

QualDerm Partners is seeking a Credentialing Specialist to oversee provider credentialing, payer enrollment, and privileging across regions, ensuring timely on-boarding and compliance with NCQA, Joint Commission, URAC, CMS rules.

Reporting to the Senior Director, Credentialing and Revenue Cycle, you will maintain data integrity in credentialing databases, collaborate with payers and health systems, train new staff, and support regional leadership.