credentialing manager

OneOncology

<div><div><div><div><div><div><div><div>OneOncology is positioning community oncologists to drive the future of cancer care through a patient-centric, physician-driven, and technology-powered model to help improve the lives of everyone living with cancer. Our team is bringing together leaders to the market place to help drive OneOncology&rsquo;s mission and vision.</div></div></div></div></div></div></div>
Why join us? This is an exciting time to join OneOncology. Our values-driven culture reflects our startup enthusiasm supported by industry leaders in oncology, technology, and finance. We are looking for talented and highly-motivated individuals who demonstrate a natural desire to improve and build new processes that support the meaningful work of community oncologists and the patients they serve.
Job Description:
The Credentialing Specialist will report to OneOncology&rsquo;s Credentialing Manager. The credentialing specialist is responsible for all aspects of the privileging and credentialing process for physicians and allied health professionals. The Specialist will process applications, verify information, research application details, and assure processes are in accordance with medial staff procedures. The specialists will provide consistent, accurate, and timely credentialing support, enhancing the organizations ability to provide professional services. Work includes the accurate, timely and documented verification of the information provided by the application and maintenance of the highly confidential credentialing related files.
Responsibilities<ul><li>
Credentialing and re-credentialing of physicians and allied health professionals</li><li>
Completion, submission and tracking of credentialing applications with all managed care organizations and hospitals.
</li><li>Apply and validate hospital privileges</li><li>
Obtain malpractice insurance policy</li><li>
Notification to staff of completion of credentialing for scheduling and billing</li><li>
Maintain and update CAQH online credentialing application for all providers quarterly.
</li><li>Database management/provider files</li><li>
Maintain vital provider credentialing information via technology tool and hard copies of documents in provider files stored on OneOncology platform.
</li><li>Tracking and maintaining all clinical licenses for nursing, pharmacy, and lab personnel</li><li>
Provider continuing education</li><li>
Track continuing education credits for all providers</li><li>
Notify providers of any deficiencies</li><li>
Submit documentation if providers are audited</li><li>
Termination of physician and/or allied health professional</li><li>
Contact all MCO/hospitals/EMR to remove provider who has left practice, within 30 days of termination.
</li></ul>Key Competencies<ul><li>
Proficient with MS Office Suite (word, excel) and web-based applications</li><li>
Ability to maintain verbal and written communications in a confidential manner</li><li>
Detail oriented with strong organizational skills</li><li>
Excellent interpersonal skills &ndash; team player who can prioritize multiple responsibilities, manage a large workload within tight deadlines &ndash; works well under pressure and consistently meets deadlines, readily adapts to change, and excels in a productivity-based environment</li><li>
Excellent verbal and written communication skills</li><li>
Demonstrates research and problem-solving skills</li></ul>
Qualifications<ul><li>
High school diploma and 2+ years of related experience.
</li><li>Bachelor&rsquo;s degree preferred.
</li><li>Training experience preferred but not required</li><li>
Industry experience leading credentialing activities in large provider practice (or multiple practices) is required</li><li>
Certifications preferred but not required</li><li>
Working remote with Travel flexibility as needed.</li></ul><h3 class="jobSectionHeader">
#LI-REMOTE</h3></div>

Credentialing Specialist

Fearless Care LLC

Job OverviewWe are seeking an experienced and highly organized Practice Manager to lead and oversee the daily operations of a multi-specialty healthcare or dental practice. This pivotal role combines strategic leadership with hands-on management to ensure the practice runs smoothly, efficiently, and in compliance with all regulatory standards. The Practice Manager will serve as the backbone of the clinic, fostering a positive environment for staff and patients alike while driving operational excellence and financial sustainability. If you thrive in gratifying, team-based settings, possess strong management skills, and have a passion for delivering exceptional patient care, this is your opportunity to make a meaningful impact.Responsibilities<ul><li>Billing &amp; Revenue Cycle</li><li>Primary liaison to our third-party billing company &mdash; weekly touchbase, AR monitoring, denial tracking</li><li>Audit upstream billing processes to catch eligibility and authorization gaps before claims go out</li><li>Monitor and report on key revenue cycle metrics monthly to Practice Owner</li></ul>Insurance Verification &amp; Contracting<ul><li>Oversee insurance verification and eligibility for all patient visits</li><li>Maintain and manage payer contracts, fee schedules, and renewal timelines</li><li>Working knowledge of Medicare, Medicaid, Sentara/Optima, Anthem/Carelon required</li></ul>Credentialing<ul><li>Manage credentialing and re-credentialing for all six providers across all payer panels</li><li>Maintain CAQH profiles, track all license and certification expirations, coordinate new provider enrollment</li></ul>Compliance &amp; HIPAA<ul><li>Maintain HIPAA compliance documentation and coordinate annual staff training</li><li>Oversee OSHA compliance, policy and procedure manual, and Spravato REMS program compliance</li></ul>HR &amp; Payroll<ul><li>Manage hiring coordination, onboarding, and employee file maintenance</li><li>Audit timekeeping records and prepare payroll summary reports for owner approval each pay period</li><li>Maintain performance documentation and support owner with corrective actions</li></ul>Operations &amp; Reporting<ul><li>Serve as on-site operational authority</li><li>Submit weekly written operations summary to remote Practice Owner</li><li>Manage vendor relationships, supply oversight, and EHR administration</li></ul>Requirements<ul><li>Minimum 3 years of verifiable medical practice management experience</li><li>Hands-on credentialing and payer enrollment experience &mdash; not just oversight</li><li>Direct experience as liaison to a third-party billing company</li><li>Strong knowledge of insurance verification, payer contracting, and revenue cycle</li><li>Prior HR experience in a healthcare setting</li><li>Ability to work independently under a remote owner &mdash; proactive communication is non-negotiable</li><li>Strong written communication skills &mdash; weekly reporting is a core function of this role</li></ul>Preferred Qualifications<ul><li>Primary care or behavioral health outpatient experience</li><li>Familiarity with Virginia payers including Sentara/Optima and Anthem/Carelon</li><li>Tebra or similar EHR/practice management system experience</li></ul>What We Offer<ul><li>$32,000-$38,000 annually commensurate with experience. Bonuses for meeting goals.</li><li>Predictable Monday&ndash;Thursday schedule, extra ours urgent/emergent only</li><li>20-24 hours/week &mdash; work-life balance without sacrificing meaningful responsibility</li><li>Autonomous role with real ownership of your function areas</li><li>A growing independent practice that values competence and initiative</li></ul>Pay: $32,000.00 - $38,000.00 per yearBenefits:<ul><li>Paid time off</li></ul>Education:<ul><li>Bachelor's (Preferred)</li></ul>Experience:<ul><li>Practice management: 1 year (Required)</li></ul>Work Location: In person

Practice Manager

Jawa Health Care

Job Title: Credentialing Expert Department: Credentialing / RCM Industry: Healthcare / DME Experience: 1&ndash;3 years (Fresh + Experienced can apply)Job SummaryWe are looking for a detail-oriented Credentialing Expert to manage provider enrollment, re-credentialing, and compliance with insurance networks. The ideal candidate will ensure timely onboarding of providers and maintain accurate credentialing records.Key Responsibilities<ul><li>Handle provider enrollment with Medicare, Medicaid, and commercial payers</li><li>Manage CAQH profiles (creation, updating, attestation)</li><li>Submit and track credentialing and re-credentialing applications</li><li>Follow up with insurance companies for application status</li><li>Maintain provider documentation (licenses, NPI, DEA, malpractice insurance)</li><li>Ensure compliance with payer requirements and deadlines</li><li>Resolve credentialing-related issues and delays</li><li>Maintain accurate records in credentialing systems</li></ul>Requirements<ul><li>Bachelor&rsquo;s degree (preferred)</li><li>Knowledge of US healthcare credentialing process</li><li>Familiarity with CAQH, PECOS, NPPES</li><li>Strong communication and follow-up skills</li><li>Good command of MS Excel and documentation</li></ul><ul><li>Shift: Night shift (US timing)</li><li>6pm to 3am</li><li>Monday to Friday</li><li>Saturday Sunday off</li><li>Location: On-site</li><li>Salary: Market competitive</li><li>Perks: Growth, training,</li></ul>Job Type: Full-timePay: Rs40,000.00 - Rs50,000.00 per monthWork Location: In person

Credentialing Expert

Speak Viral

We are looking for a Credentialing Specialist to join our team and oversee administrative tasks dealing with our health facility&rsquo;s credentialing.Credentialing Coordinator responsibilities include maintaining and verifying files and tracking the expiration of certifications throughout the organization.Ultimately, you will work with different departments across our organization to ensure staff members have the necessary accreditations needed throughout the year.Responsibilities<ul><li>Identify discrepancies in information and conduct follow-ups</li><li>Present applications to the facility&rsquo;s Credentialing Committee</li><li>Assist customers with credentialing inquiries</li><li>Respond to health plan provider inquiries</li><li>Capture primary source documentation in computer databases</li><li>Ensure data is backed up</li><li>Follow compliance laws, regulations, procedures, and policies</li></ul>Requirements and skills<ul><li>Proven work experience as a Credentialing Coordinator or similar role</li><li>Excellent verbal and written communication skills</li><li>Expertise with Microsoft Office Word and Excel</li><li>Proficient touch-typing skills</li><li>Ability to focus for extended periods</li><li>Relevant training and/or certifications as a Credentialing Coordinator</li></ul>Job Type: Full-timePay: Rs50,000.00 - Rs70,000.00 per monthApplication Question(s):<ul><li>Will you be able to work in night shift(6pm to 3am)?</li><li>Will you be able to commute to Bahria Town Phase 7 Rawalpindi?</li></ul>Work Location: In person

Prima Systems

We are seeking a detail-oriented and experienced Credentialing and Enrollment Associate to join our medical billing team. The ideal candidate will have a strong background in healthcare credentialing and enrollment processes, particularly within the US healthcare system. This role will involve ensuring that healthcare providers are properly credentialed with insurance networks and government programs, facilitating enrollment, and maintaining accurate records.Responsibilities:<ul><li>Manage the credentialing and enrollment process for healthcare providers with insurance networks, Medicare, Medicaid, and other relevant programs.</li><li>Prepare and submit credentialing applications, re-credentialing, and revalidation documents accurately and timely.</li><li>Ensure compliance with all credentialing requirements, regulations, and standards set by accrediting bodies and government agencies.</li><li>Communicate with insurance companies, providers, and internal stakeholders to resolve credentialing issues and inquiries.</li><li>Maintain up-to-date knowledge of current healthcare regulations, policies, and procedures related to credentialing and enrollment.</li><li>Coordinate with internal departments to gather necessary documents and information for credentialing applications.</li><li>Monitor the status of applications, track expirations, and follow up on pending items to ensure timely completion.</li><li>Maintain accurate and organized credentialing and enrollment records, both electronic and paper-based.</li><li>Assist in audits and reviews related to credentialing and enrollment processes.</li></ul>Requirements:<ul><li>Graduation is mandatory.</li><li>Minimum of 06 months of experience in healthcare credentialing and enrollment, preferably in a medical billing setting.</li><li>In-depth knowledge of credentialing processes for insurance networks, Medicare, Medicaid, and other payers.</li><li>Familiarity with CAQH, NPI, UPIN, and other relevant healthcare databases and identifiers.</li><li>Strong understanding of healthcare regulations, compliance standards, and HIPAA guidelines.</li><li>Excellent English communication skills, both verbal and written, with the ability to interact professionally with providers and insurance representatives.</li><li>Exceptional attention to detail, accuracy, and organizational skills.</li><li>Proficiency in using MS Office applications and credentialing software.</li><li>Ability to work independently, prioritize tasks, and meet deadlines in a fast-paced environment.</li></ul>Job Type: Full-timePay: Rs60,000.00 - Rs75,000.00 per monthApplication Question(s):<ul><li>Are you available for night shift</li></ul>Experience:<ul><li>Credentialing in Medical Billing: 1 year (Preferred)</li></ul>Language:<ul><li>English (Preferred)</li></ul>Work Location: In person

Credentialing Associate

International Association of Assessing Officers

The Credentialing Coordinator is a non-exempt position that reports directly to the Credentialing Director and supports the operations of the Professional Development Department. This role assists IAAO program participants in their pursuit of professional credentials by providing high-quality, responsive customer service and ensuring the smooth, accurate administration of credentialing programs.The position is administrative and clerical in nature and requires knowledge of established methods, procedures, and systems used within a professional office environment. Work is performed under established guidelines, with complex or unusual issues referred to the Credentialing Director or department leadership. The Credentialing Coordinator supports credentialing programs through precise and courteous correspondence, accurate data entry, documentation review, database management, document preparation, and coordination of program-related activities.ESSENTIAL FUNCTIONS<ul><li>Provide high-level, professional customer service when representing credentialing programs and the Professional Development Department internally and externally.</li><li>Respond to inquiries from prospects, program participants, staff, committees, and other stakeholders via phone, email, and other communication platforms.</li><li>Review applications, documentation, and supporting materials for completeness, accuracy, and compliance with program requirements; identify and request additional information as needed.</li><li>Accurately record, update, and maintain credentialing and account records within association management systems and databases, including correcting errors and adding new records.</li><li>Modify and maintain databases and database management systems; perform routine audits to ensure data integrity.</li><li>Assist with maintaining credentialing program systems and tools, including website and social media updates in coordination with internal departments as needed.</li><li>Prepare, compose, and manage correspondence, including emails, letters, reports, and other program-related documents.</li><li>Maintain electronic filing systems; scan and file documents, invoices, and checks in accordance with department procedures.</li><li>Collect, sort, prepare, and distribute mail, messages, and courier deliveries.</li><li>Assist with processing payments, orders, and program-related transactions.</li><li>Support major mailings, member campaigns, credentialing cycles, and other association activities.</li><li>Cross-train in other Professional Development Department functions and assist with special projects as assigned.</li></ul>SECONDARY FUNCTIONS<ul><li>Perform other related duties as required to support department and organizational goals.</li></ul>SUPERVISORY FUNCTIONS<ul><li>None.</li></ul>KNOWLEDGE AND PROFICIENCY<ul><li>Knowledge of Microsoft Office Suite, including Outlook, Word, Excel, PowerPoint, Access, Publisher, and Adobe products.</li><li>Proficiency with association management systems, databases, and other software used to support credentialing and professional development programs.</li></ul>SKILLS<ul><li>Strong data entry skills with a high degree of accuracy and efficiency.</li><li>Excellent proofreading skills, including attention to grammar, spelling, formatting, and sentence structure.</li><li>Strong organizational, planning, and time-management skills.</li><li>Effective written and verbal communication skills appropriate for a customer service-oriented professional environment.</li><li>Ability to manage multiple priorities in a fast-paced environment with attention to detail.</li></ul>ABILITIES<ul><li>Ability to work independently and collaboratively as part of a team.</li><li>Ability to establish and maintain positive working relationships with staff, members, candidates, volunteers, committees, and external partners.</li><li>Ability to meet deadlines and manage competing priorities.</li><li>Ability to work additional hours and travel overnight as needed.</li><li>Ability to read and interpret policies, procedures, manuals, and program requirements.</li><li>Ability to prepare routine reports and correspondence.</li><li>Ability to communicate effectively with customers, coworkers, and stakeholders.</li><li>Ability to perform basic mathematical functions, including addition, subtraction, multiplication, division, percentages, ratios, and interpretation of basic data.</li><li>Ability to apply common-sense understanding to carry out detailed written or oral instructions and resolve routine problems.</li></ul>COMPETENCIESTo perform the job successfully, an individual should demonstrate the following competencies:<ul><li>Adaptability: Adapts to changes in the work environment; manages competing demands; adjusts approach as needed; handles frequent change or unexpected events effectively.</li><li>Analytical Skills: Synthesizes information; researches data; uses experience and judgment to support decision-making; assists in improving workflows and procedures.</li><li>Customer Service: Responds promptly to customer needs; manages difficult situations professionally; meets commitments; seeks opportunities to improve service.</li><li>Interpersonal Skills: Maintains confidentiality; listens actively; remains open to ideas; resolves conflict constructively.</li><li>Oral Communication: Communicates clearly and professionally; listens for understanding; responds effectively to questions; participates in meetings.</li><li>Problem Solving: Identifies issues; gathers and analyzes information; develops practical solutions; exercises sound judgment.</li><li>Project Management: Assists with planning and coordinating projects; tracks progress; completes assigned tasks on time.</li><li>Quality: Demonstrates accuracy and thoroughness; applies feedback; monitors work to ensure high quality standards.</li><li>Teamwork: Balances individual and team responsibilities; supports team objectives; contributes to a positive work environment.</li><li>Written Communication: Writes clearly and effectively; edits for grammar and clarity; presents information accurately and professionally.</li></ul>CERTIFICATIONS, LICENSES, REGISTRATIONS<ul><li>None.</li></ul>REQUIRED EDUCATION AND/OR EXPERIENCE<ul><li>Minimum of two years of administrative experience in a professional office environment.</li><li>Associate degree or some college coursework preferred.</li><li>Excellent organizational skills, including the ability to set priorities, coordinate projects, and follow up with minimal supervision.</li></ul>Job Type: Full-timeExperience:<ul><li>Administrative: 2 years (Preferred)</li></ul>Work Location: Hybrid remote in Kansas City, MO 64105

Credentialing Coordinator

Physicians Revenue Group

<ul><li>erform end-to-end credentialing and re-credentialing for healthcare providers with US insurance payers</li><li>Handle payer enrollments (Medicare, Medicaid, and commercial plans) to ensure billing readiness</li><li>Maintain and regularly update CAQH profiles, ensuring accuracy for claim processing</li><li>Verify provider eligibility before onboarding to avoid claim rejections/denials</li><li>Coordinate closely with medical billing teams to resolve credentialing-related claim issues</li><li>Monitor and follow up on pending applications to prevent revenue delays</li><li>Ensure all provider data (NPI, taxonomy, licenses, malpractice insurance) is accurate and up to date</li><li>Work on ERA/EFT enrollments to streamline payment processes</li><li>Support denial management by identifying credentialing gaps impacting reimbursements</li><li>Maintain compliance with payer-specific guidelines and regulatory requirements</li><li>Prepare credentialing status reports, turnaround time tracking, and aging reports</li></ul>Job Type: Full-timeWork Location: In person

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