Position Summary
We are seeking a detail-oriented, proactive, and organized Part-Time Credentialing Specialist to manage our provider enrollment, insurance credentialing, and network maintenance lifecycle. The ideal candidate will ensure that all clinical and facility credentials are authenticated, updated, and compliant with state, federal, and payer-specific standards.
Key Responsibilities
Provider & Facility Credentialing: Process initial credentialing and re-credentialing applications for physicians, allied health professionals, and facilities with commercial and government payers.
Primary Source Verification: Authenticate licenses, certifications, malpractice coverage, DEA registrations, and CVs/resumes.
Payer Enrollment & Maintenance: Manage CAQH profiles, update provider rosters, and track enrollment applications from initial submission to active network status.
Compliance & Auditing: Maintain audit-ready credentialing files and monitor upcoming expiration dates for licenses and certifications to prevent network lapses.
Cross-Functional Collaboration: Partner with the billing, compliance, and human resources teams to resolve provider data discrepancies and streamline onboarding workflows.
Qualifications & Requirements
Experience: 1–3+ years of professional experience in healthcare credentialing, provider enrollment, or medical office administration.
Knowledge: Familiarity with NCQA, CMS guidelines, and commercial/Medicaid insurance networks. [1]
Technical Skills: Proficiency with CAQH, electronic credentialing databases, and office productivity tools (Google Workspace or Microsoft Office).
Soft Skills: Exceptional written and verbal communication skills, high attention to detail, and the ability to work independently in a remote environment.