credentialing specialist

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

Caravel Autism Health

<div>
 
 The Credentialing Specialist is responsible for all credentialing activities and initial analysis of new contracts.&nbsp;
 
 
 
 &nbsp;
 
 
 Essential Functions
 
 
 
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 &nbsp;
 
 
 <li>
 Responsible for the oversight of all credentialing activities. &nbsp;This includes completion and submission of applications and following up with providers and payors on incomplete items.
 </li>
 
 <li>
 Works with payors to add new locations to existing contracts.
 </li>
 
 <li>
 Maintains good working relationships with payor contacts.
 </li>
 
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 Performs initial review of new payor contracts and suggests changes to discuss with Director.
 </li>
 
 <li>
 Acts as a credentialing resource for providers.
 </li>
 
 <li>
 Ensures department operations are performed in an accurate and timely manner.
 </li>
 
 <li>
 Identifies and suggests process improvement goals to support operations.&nbsp;
 </li>
 
 <li>
 Develops and maintains partnerships across all other departments, partners, and vendors to develop and integrate solutions in support of business objectives.
 </li>
 
 
 
 
 &nbsp;
 
 
 
 
 
 
 
 Non-Essential Functions/Other Duties
 
 
 
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 1. &nbsp; Performs other duties as assigned&nbsp;
 
 
 
 
 
 Supervisory Responsibility
 
 
 
 : &nbsp;
 
 
 
 
 Leads, coaches, and mentors Billing &amp; Authorization Staff. &nbsp;&nbsp;
 
 
 
 
 
 Travel Required
 
 
 
 : &nbsp;
 
 Occasional travel may be required. &nbsp;
 
 
 
 
 
 Physical Demands
 
 
 
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 This is largely a sedentary role, with frequent sitting and computer keyboarding required. &nbsp;Employee will be required to sit, talk, hear, type and write. &nbsp;Occasional bending, squatting, stooping, and lifting (up to 35 pounds) are required. &nbsp;
 
 
 
 
 
 Qualifications
 
 
 
 :
 
 
 
 
 
 Education: &nbsp;
 
 
 
 <ul>
 
 <li>
 At least a Bachelor&rsquo;s Degree in a healthcare or business related discipline, or equivalent experience&nbsp;
 </li>
 
 <li>
 Certification is a plus
 </li>
 
 </ul>
 
 
 
 Experience:
 
 
 
 <ul>
 
 <li>
 At least three years of medical insurance, billing or claims experience, preferably in a supervisory capacity
 </li>
 
 <li>
 Previous management level experience preferred
 
 &nbsp;
 </li>
 
 </ul>
 
 
 
 Skills and Competencies:
 
 
 
 <ul>
 
 <li>
 Knowledge of medical billing and ICD-10, and CPT coding, as well as knowledge of financial concepts &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;
 </li>
 
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 Strategic focus, with the ability to identify and execute on key business strategies that will support attainment of overall organizational business objectives
 </li>
 
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 Ability to effectively lead, coach, manage, mentor and develop others, holding staff accountable as appropriate
 </li>
 
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 Excellent interpersonal skills, with the ability to communicate effectively with others
 </li>
 
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 Able to work both independently and be self-directed, as well as being able to perform in a team atmosphere &nbsp;
 </li>
 
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 Displays professionalism and represents organization in a professional manner
 </li>
 
 <li>
 Strong knowledge of HIPPA privacy and security rules and regulations
 </li>
 
 </ul>
 
 
 attached
 
 
 
 
 
 
 
 Caravel Pay Details:
 
 
 
 &middot; &nbsp; &nbsp; &nbsp; &nbsp;$18.18 to $20.00
 
 
 
 Compensation for the role will depend on a number of factors, including a candidate&rsquo;s qualifications, skills, competencies and experience and may fall outside of the range shown. At Caravel we provide competitive wages with excellent benefits, including medical and dental insurance, employer-matched 401(k), paid time-off, paid travel, short-term disability and more.&nbsp;
 
 
 
 Important: Credentialing Specialist is a Full Time remote/work from home
 
 
 
 opportunity, and we are open to candidates in the Spokane, WA OR Green Bay, WI areas
 
 
 
 &nbsp;
 
</div>

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

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

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>Minimum of 2-3 years 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: Rs100,000.00 - Rs130,000.00 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

Respiratory Critical Care and Sleep Medicine Associates, Inc.

Job Summary- This job is not a remote position- The Credentialing Specialist is responsible for managing all aspects of provider credentialing, recredentialing, and enrollment with insurance payers, hospitals, and regulatory agencies. This role ensures providers are properly credentialed and compliant to maintain uninterrupted reimbursement and participation.Key Responsibilities<ul><li>Coordinate and maintain provider credentialing and recredentialing with commercial payers, Medicare, and Medicaid</li><li>Complete and submit provider enrollment applications (CAQH, PECOS, and state Medicaid portals)</li><li>Track and monitor credentialing application status and follow up as needed</li><li>Maintain accurate provider files and credentialing databases</li><li>Ensure compliance with regulatory requirements and payer guidelines</li><li>Assist with hospital privileging applications</li><li>Maintain CAQH profiles and attestations</li><li>Monitor expiring licenses, certifications, DEA registrations, and malpractice coverage</li><li>Work closely with the billing department to resolve enrollment-related claim issues</li></ul>Qualifications<ul><li>2+ years of medical credentialing experience (preferred in a specialty practice)</li><li>Knowledge of Medicare, Medicaid, and commercial insurance enrollment processes</li><li>Experience with CAQH, PECOS, and provider enrollment portals</li><li>Strong organizational and follow-up skills</li><li>Excellent communication skills</li><li>Proficiency in Excel and Microsoft Office</li></ul>Compensation &amp; Benefits<ul><li>Competitive salary (based on experience)</li><li>Health, dental, and vision insurance</li><li>Paid time off</li><li>Retirement plan options</li><li>Supportive team environment</li></ul>We are a dedicated respiratory care and sleep medicine facility committed to delivering exceptional patient care through a team of skilled providers and support staff. As we continue to grow, we are seeking a Credentialing and Administrative Assistant to help us ensure that our providers are fully credentialed, enrolled, and supported in their clinical and operational efforts.Pay: $20.00 - $23.00 per hourExperience:<ul><li>credentialing : 3 years (Required)</li></ul>Ability to Commute:<ul><li>Jacksonville, FL 32207 (Required)</li></ul>Ability to Relocate:<ul><li>Jacksonville, FL 32207: Relocate before starting work (Required)</li></ul>Work Location: In person

Credentialing Specialist Part-time

Macrise Tech Solutions

The Credentialing Specialist is responsible for managing the complete lifecycle of provider credentialing and re-credentialing across various insurance networks, payers, and credentialing platforms. This role requires a proactive, detail-oriented professional with strong follow-up capabilities to ensure ongoing regulatory compliance, uninterrupted provider participation, and efficient billing and authorization workflows. The position plays a critical role in supporting operational efficiency and ensuring accurate, timely reimbursements.Key ResponsibilitiesCredentialing &amp; Compliance<ul><li>Maintain, organize, and regularly update provider credentialing records for both commercial and government payers.</li><li>Oversee and manage CAQH profiles to ensure compliance with CMS regulations and payer-specific credentialing standards.</li><li>Process initial credentialing, re-credentialing, and payer enrollment applications for Medicare, Medicaid, and commercial insurance networks.</li><li>Manage applications, renewals, and documentation related to professional licenses, DEA registrations, and controlled substance certifications.</li><li>Complete provider revalidation processes with government and regulatory bodies within required timelines.</li><li>Coordinate hospital credentialing activities, including managing provider privileges and maintaining active affiliations.</li></ul>Collaboration &amp; Operational Support<ul><li>Work closely with the Revenue Cycle Director and Billing Team to resolve credentialing-related denials, payer concerns, and authorization delays.</li><li>Ensure provider data is accurate and consistent across CAQH, PECOS, NPPES, CMS databases, and internal systems.</li><li>Maintain a centralized credentialing tracker, including provider credentials, expiration dates, payer participation status, and system access information.</li><li>Provide administrative support for credentialing audits, compliance reviews, and regulatory documentation as required</li></ul>Job Type: Full-timePay: Rs45,000.00 - Rs80,000.00 per monthAbility to commute/relocate:<ul><li>Wapda Town: Reliably commute or planning to relocate before starting work (Required)</li></ul>Application Question(s):<ul><li>Willing to work the night shift in Wapda Town, Lahore?</li></ul>Experience:<ul><li>Credentialing: 1 year (Preferred)</li></ul>Language:<ul><li>English (Required)</li></ul>Work Location: In person

Payer Enrollment & Credentialing Specialist

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Payer Enrollment & Credentialing Specialist