Remote Provider Credentialing Specialist

iCARE HEALTH SOLUTIONS; United States; Remote; USD 60,000 - 75,000; Full time

Job summary

iCARE HEALTH SOLUTIONS seeks a Credentialing Specialist to build relationships with providers, retail chains, and partners while guiding initial and ongoing credentialing processes.

You will ensure documentation meets state regulations, manage files in partner systems, and collect missing items to maintain timely regulatory compliance. Strong communication and problem-solving skills are essential.

Qualifications

• Bachelor's degree in a related field, or 4 years of relevant experience.
• Strong written and verbal communication, influencing and problem-solving skills.
• Experience credentialing providers and staff; discretion in daily duties.
• Ability to identify problems and provide creative solutions that align with policies.
• Excellent attention to detail, multitasking, organizational skills, and customer service.

Responsibilities

• Establish relationships with providers to obtain regulatory information and manage initial and ongoing credentialing.
• Ensure documentation complies with state regulations using independent judgment.
• Oversee and manage provider files in the CVO partner’s system.
• Track progress of credentialing files, collect missing documents, and meet regulatory standards.
• Research and resolve credentialing issues, coordinating with partners to meet regulatory requirements.
• Collect, evaluate, and compile information to explain provider sanctions or malpractice claims.
• Prepare information for the Credentialing Committee to render decisions on applications.
• Maintain accuracy of provider data and share knowledge as an internal resource.
• Escalate issues and drive solutions across business areas.
• Gather information for the legal department to support disputes for denied/terminated providers.
• Compose professional correspondence to providers, chains, and staff.
• Support growth objectives and operational goals as a knowledgeable internal resource.

Skills

Communication skills

Leadership

Problem-solving

Discretion/Independent judgment

Attention to detail

Multitasking

Organizational skills

Customer service

Team collaboration

Education

Bachelor's degree in related field

4 years of functional experience in lieu of degree

Job description

iCARE HEALTH SOLUTIONS seeks a Credentialing Specialist to build relationships with providers, retail chains, and partners while guiding initial and ongoing credentialing processes.

You will ensure documentation meets state regulations, manage files in partner systems, and collect missing items to maintain timely regulatory compliance. Strong communication and problem-solving skills are essential.