Remote Credentialing Specialist I - Healthcare

Partner's Healthcare; Somerville (MA); On-site; USD 24,000 - 35,000; Full time

Job summary

Mass General Brigham Health Plan Holding Company, Inc. is seeking a Credentialing Coordinator I to process, review, and maintain provider and facility credentialing files within defined turnaround and quality standards.

You will collaborate with the management team to monitor workflows, assist with revisions, and distribute daily assignments in the manager's absence. The ideal candidate has 1-2 years in Clinical/Medical Office settings, strong knowledge of credentialing processes, and

Qualifications

• Experience with audits, credentialing, or reading credentialing files is highly preferred.
• 1-2 years of experience in Clinical/Medical Office/Healthcare required.
• 2-3 years credentialing experience, with at least 1 year in a health insurance environment, highly preferred.
• Knowledge of OneCare and SCO highly preferred.
• Remote work within US states is acceptable for this role.

Responsibilities

• Enter and update provider and facility data in credentialing databases (PEP, QNXT) per input standards.
• Coordinate initial and re-credentialing within established turnaround times.
• Verify credentialing elements (license, DEA, board certification, NPDB) via CVO and document status.
• Assist with committee meetings and respond to inquiries when the manager is absent.
• Ensure compliance with state and NCQA requirements and maintain quality standards.

Skills

Credentialing knowledge

Communication skills

Judgment and discretion

Multitasking

Information research

Education

Associate's Degree

Tools

Microsoft Office

Job description

Mass General Brigham Health Plan Holding Company, Inc. is seeking a Credentialing Coordinator I to process, review, and maintain provider and facility credentialing files within defined turnaround and quality standards.

You will collaborate with the management team to monitor workflows, assist with revisions, and distribute daily assignments in the manager's absence. The ideal candidate has 1-2 years in Clinical/Medical Office settings, strong knowledge of credentialing processes, and