Remote Credentialing Specialist III

University of Houston; Newport Beach (CA); Híbrido; USD 36.000 - 55.000; Jornada completa

Descripción de la vacante

Guardian Life seeks a Credentialing Support Associate III to maintain accurate provider records and support credentialing and recredentialing within regulatory and NCQA standards. You will coordinate outreach, resolve discrepancies, and ensure complete credentialing files in a fast-paced healthcare environment.

The role emphasizes attention to detail, data accuracy, and strong communication with providers and internal teams to support compliant network operations.

Formación

• High school diploma or equivalent; Associate's or Bachelor's degree preferred.
• Experience supporting provider credentialing, healthcare operations, provider enrollment, or administrative processes.
• Experience maintaining and updating data within databases or business systems.
• Strong attention to detail and commitment to data accuracy.
• Excellent verbal and written communication skills.
• Ability to follow established processes and regulatory requirements.
• Strong organizational and time management skills.
• Ability to manage multiple priorities in a deadline-driven environment.
• Proficiency with Microsoft Office applications, including Excel and Outlook.

Responsabilidades

• Maintain accurate provider information by entering, updating, and auditing data within credentialing systems.
• Coordinate recredentialing activities, including distributing recredentialing communications and monitoring provider responses.
• Communicate with providers to obtain missing documentation, resolve discrepancies, and ensure complete credentialing files.
• Conduct primary source verification activities for initial credentialing and recredentialing applications in accordance with regulatory requirements and company standards.
• Track and follow up on outstanding credentialing requirements to support timely processing and compliance.
• Partner with internal stakeholders to ensure provider records are accurate, complete, and compliant with organizational policies.
• Support continuous improvement efforts that enhance credentialing processes and data quality.

Conocimientos

Attention to detail

Verbal and written communication

Regulatory compliance

Time management

Multitasking

Educación

High school diploma or equivalent

Associate's or Bachelor's degree preferred

Herramientas

Microsoft Office (Excel, Outlook)

Descripción del empleo

Guardian Life seeks a Credentialing Support Associate III to maintain accurate provider records and support credentialing and recredentialing within regulatory and NCQA standards. You will coordinate outreach, resolve discrepancies, and ensure complete credentialing files in a fast-paced healthcare environment.

The role emphasizes attention to detail, data accuracy, and strong communication with providers and internal teams to support compliant network operations.