Credentialing Coordinator

Threat Intelligence SpecialistSecurity AnalystFull TimeRemote

Location

United States

Posted

14 days ago

Salary

Not specified

No structured requirement data.

Job Description

We are seeking an experienced Provider Credentialing Specialist to join our growing team. The ideal candidate will have a strong background in multi-state credentialing, with specific experience credentialing for Primary, Cardiology, Dental, and Anesthesia providers. This role requires exceptional attention to detail, accuracy, and the ability to work independently while managing multiple provider files across various payors and states. Complete provider credentialing and recredentialing applications for multiple specialties, including Cardiology, Dental, and Anesthesia. Navigate and comply with state-specific Medicaid and Medicaid MCO credentialing requirements. Maintain accurate records of provider files, applications, and payer correspondence. Update and maintain provider information in credentialing databases such as CAQH, PECOS, NPPES, and other payor-specific platforms. Follow up with payors, providers, and internal teams to ensure timely completion of all credentialing processes. Build and maintain relationships with Insurance representatives throughout the credentialing process to ensure up-to-date and timely responses. Navigate through several different state portals to obtain the proper information to begin the credentialing or recredentialing process. Interpret and apply plan-specific rules and state requirements for credentialing in each assigned region. Support ongoing growth—currently managing credentialing for 11 states, 26 providers, and 141 locations (and expanding). Manage and track all work using an Excel spreadsheet.

Job Requirements

  • Minimum 5 years of experience in provider credentialing (multi-state preferred).
  • In-depth knowledge of CAQH, PECOS, NPPES, and commercial payor platforms.
  • Proven experience with Medicaid and Medicaid Managed Care Organizations (MCOs).
  • Strong understanding of payer enrollment processes for both commercial and government plans.
  • Excellent organizational skills and follow-up practices.
  • Self-motivated, detail-oriented, and able to work independently.
  • Experience with Cardiology, Dental, or Anesthesia credentialing is highly preferred.
  • Experience using Excel and knowing how to create pivot tables and organize, track, and follow up on all providers using this type of platform.
  • CPCS (Certified Provider Credentialing Specialist) preferred but not required.
  • Full time
  • Competitive hourly rate based on experience
  • Rate: $21.00 - 23.00/hour
  • How to Apply
  • To apply, please submit your resume and a cover letter highlighting your relevant experience and send to: [email protected]
  • NOTE: YOUR APPLICATION WILL NOT BE REVIEWED WITH A RESPONSE IF, I DO NOT RECEIVE A COVER LETTER WITH YOUR RESUME UPLOADED.
  • IF YOU ARE NOT IN ONE OF THE 50 STATES IN THE US I WILL NOT REVIEW YOUR RESUME.

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