credentialing specialist

HA-Technologies

WE ARE HIRINGCredentialing Specialist on urgent basis.━━━━━━━━━━━━━Company: MedxCode LLC.Location: Blue Area, IslamabadExperience: minimum 2 YearsKey Responsibilities:* Submitting credentialing applications for healthcare providers.* Follow-up with insurance companies regarding application status.* Managing and updating CAQH profiles.* Performing CAQH Attestation.* Ensuring all provider documents are complete and accurate.Perks &amp; Benefits:* Competitive salary package.* Friendly and professional work environment.* Learning and career growth opportunities.* Paid leaves as per company policy.Application Question(s):<ul><li>How many years of experience do you have in medical credentialing?</li><li>Do you have hands-on experience with CAQH profile management and attestation? (Yes/No)</li><li>Have you previously worked with US healthcare credentialing processes? (Yes/No)</li><li>Can you handle credentialing applications submission and follow-ups with insurance companies independently? (Yes/No)</li><li>Which credentialing software/tools have you used?</li><li>Are you familiar with insurance panels and provider enrollment processes? (Yes/No)</li><li>How soon can you join?</li><li>What is your expected salary?</li></ul>Work Location: In person

Credentialing Specialist

HBSS ACADEMY

Credentialing SpecialistExperience- 3 to 4 years Provenlocation- J Block, LDA Avenue One LahoreSalary: 100K to 120KTiming- US EST- 6 pm to 3 am in summer and 7 pm to 4 am in winterRoles and Responsibilities<ul><li>Initiate enrollment with insurance companies for all new providers</li><li>Maintain the timelines on enrollment schedules, communicate with billing and the office managers on updates as needed and explain payer information requirements</li><li>Work closely with physicians and office mangers to obtain missing documentation on providers for enrollment with insurance companies</li><li>Follow-up with insurance companies for provider participation status</li><li>Complete re-credentialing for existing providers</li><li>Able to effectively communicate with team members, billing staff and insurance companies</li><li>Retain detailed and accurate lists of insurances for which clients participate</li><li>Performs other related duties, which may be inclusive, but not listed in the job description</li><li>Complete provider credentialing/contract applications with third-party carriers and government health plans.</li><li>Review provider credentialing and contracting information to ensure completeness and accuracy.</li><li>Monitor applications and follow-up in a timely manner.</li><li>Document, maintain and crosscheck client credentials in multiple databases, including CAQH and other third-party databases, as applicable.</li><li>Create, update and track provider information in the internal credentialing system to ensure that credentials are completed timely and correctly.</li><li>Meet or exceed required timeframes for provider communications, enrollments, and follow-ups.</li><li>Maintain quality working relationships with internal and external customers.</li><li>Collect, Submit, &amp; Track all necessary documentation.</li><li>Process re-credentialing for existing clinicians as required by individual payers.</li><li>Maintain a current, accurate database of all clinicians&rsquo; credentialing / licensure status, needs, expirations, issues, etc. Share with internal staff as applicable.</li><li>Communicate &amp; Coordinate with all levels of internal staff &amp; external stakeholders to ensure timely &amp; consistent qualification is met &amp; maintained.</li><li>Monitor expiring credentials to ensure ongoing compliance with regulatory guidelines.</li><li>Investigate and resolve any issues that arise during the approval process.</li><li>Under the direction of leadership, assist with site level enrollments or changes to contract.</li><li>Other duties as deemed necessary.</li></ul>Contact HR.hr@thequestmbs.com 03324641025Pay: Rs100,000.00 - Rs120,000.00 per hourExpected hours: 45.0 per weekWork Location: In person

CoreMedical Group

<div>Credentialing Specialist 
CoreMedical Group is a nationwide healthcare staffing agency located in Manchester, NH. Our company specializes in placing healthcare professionals in short term assignments at health care facilities across the United States. We currently have an internal opening for a Credentialing Specialist within our Quality Assurance Department. This is a full-time permanent position in our corporate office. 
This position is responsible for ensuring all healthcare professionals placed on assignment have all company and client facility onboarding requirements completed and active prior to assignment start date, including, but not limited to, drug screening, background checks, employment paperwork, competency testing, health screening and various other requirements. In this position, there is close coordination with other operations departments as well as the sales team. 
Summary of Job: Under the general direction of the Credentialing Specialist Team Lead, this position focuses on and is responsible for; ensuring healthcare professionals are properly credentialed prior to their assignment start date. In addition this person will have close interaction with other departments such as Sales and Operations. 

Supervisory Responsibilities: No 


Duties:
<ul>
<li>Working closely with each healthcare professional placed to coordinate and instruct on all required documentation and medical services needed for the assignment. Extensive contact with healthcare professionals throughout the process.</li>
<li>Coordination with other members of the department to arrange for background screening, drug testing and medical services required for healthcare professionals assignments; follow up as necessary.</li>
<li>Reviewing medical documentation, certifications, employment forms, testing, and all other requirements upon receipt to ensure that they meet client and company standards;</li>
<li>Working closely with internal sales teams to answer questions and provide status updates</li>
<li>Setting up online employment forms and testing for travelers as needed</li>
<li>Preparing employment packets for candidates starting assignments to forward to clients, or utilizing client web portals to upload all paperwork and documentation.</li>
<li>Daily updates of internal tracking sheet/database of all credentialing statuses</li>
<li>Other administrative tasks as related to this position</li>
<li>Performs other related duties as required.</li>
<li>
</li></ul>Required Skills/Abilities/Competencies:
<ul>
<li>Extensive knowledge of computers, Microsoft suite, expert Internet required</li>
<li>Strong proofreading skills</li>
<li>Must be self-motivated, detail-oriented individual with strong administrative skills and experience.</li>
<li>Ability to frequently change priorities and be able to multi-task in a high volume, deadline driven administrative role.</li>
<li>Must be outgoing and positive individual</li>
<li>Strong organizational &amp; communication skills are a must</li>
<li>Complete all aspects of position timely and accurately</li>
<li>Attend all required training seminars and meetings at scheduled time</li>
<li>Be able to work independently as well as part of a team.</li>
<li>Must maintain an excellent attendance and punctuality record.</li>
<li>
</li></ul>Education &amp; Experience:
<ul>
<li>High School Diploma Equivalent required</li>
<li>Must have 1 or more years of relevant or other experience</li></ul> 


Physical Requirements:
<ul>
<li>Prolonged periods of sitting and/or standing.</li>
<li>Daily use of computer system.</li></ul> 


Pay Range: Dependent on previous experience. 

Required Documentation: Confidentiality Agreement 
Core is a company that values transparency, growth, and fun. We measure success with traditional sales metrics, as well as how you fit in with and elevate our company culture. You can find our Mission and Core Values here. 
<ul>
<li>Day-1 Benefits: Take a peek at our comprehensive benefit program which includes health, vision, and even pet insurance options.</li>
<li>An evolving work environment: Remote and hybrid work schedules give you flexibility to work at home and in the office. In the office you'll have access to a fitness room, game room, and plenty of collaborative huddle spaces in a modern, bright work space.</li>
<li>Comprehensive training for new employees: We set you up for success from day one &ndash; we&rsquo;ve always got your back!</li>
<li>Recognition: Company-wide rallies, individual employee recognition, and company-sponsored outings all show our appreciation for the hard work you put in every day.</li>
<li>An all-inclusive, all expenses paid vacation: Every employee has the chance to earn a spot on our annual Club CoreMed trip to an all-inclusive resort in the Caribbean.</li>
<li>Health and wellness opportunities: Discounted gym memberships, on-site peer-chosen wellness programs, an on-site gym, hiking trails around the lake outside our door, and healthy lifestyle reimbursements to name a few.</li>
<li>An opportunity to give back: We participate in ongoing charity projects to support our local and global communities.</li>
<li>Bragging rights: When you work at Core, you&rsquo;re joining one of the Best Companies To Work For in NH.</li></ul> 


Compensation: $20.00-$23.00/hour. Depending on previous experience. 
CoreMedical Group provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability (physical/mental), genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.</div>

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

Macrise Tech Solutions

The Credentialing Specialist is responsible for overseeing the full lifecycle of provider credentialing and re-credentialing across multiple insurance networks, payers, and credentialing platforms. This role requires a proactive and detail-oriented individual with strong follow-up skills to ensure continuous compliance with regulatory standards, uninterrupted provider participation, and smooth billing and authorization processes. The position plays a vital role in maintaining operational efficiency and supporting accurate and timely reimbursements.Key ResponsibilitiesCredentialing &amp; Compliance<ul><li>Maintain, organize, and routinely update provider credentialing records for both commercial and government payers.</li><li>Manage and monitor CAQH profiles to ensure alignment with CMS regulations and payer-specific credentialing requirements.</li><li>Process initial credentialing, re-credentialing, and payer enrollment applications for Medicare, Medicaid, and commercial insurance networks.</li><li>Handle applications, renewals, and documentation related to professional licenses, DEA registrations, and controlled substance certifications.</li><li>Complete provider revalidation processes with government and regulatory agencies within defined timelines.</li><li>Coordinate hospital credentialing activities, including managing provider privileges and maintaining active affiliations.</li></ul>Collaboration &amp; Operational Support<ul><li>Partner with the Revenue Cycle Director and Billing Team to resolve credentialing-related denials, payer issues, and authorization delays.</li><li>Ensure accuracy and consistency of provider information 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 details.</li><li>Provide administrative support for credentialing audits, compliance reviews, and regulatory documentation as needed</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 (Required)</li></ul>Language:<ul><li>English (Required)</li></ul>Work Location: In person

Credentialing & Provider Enrollments Executive-Medical Billing

Oncology Nursing Society

<div>Credentialing Administrator 
Oncology Nursing Certification Corporation (ONCC&reg;) 
Remote | Full-Time 
Make a Difference That Matters
ONCC&reg; is the premier provider of nationally accredited certification for nurses in oncology and related specialties. Founded in 1984 as a non-profit organization, ONCC administered the first Oncology Certified Nurse (OCN&reg;) examination in 1986. Today, ONCC offers multiple credential programs, has more than 42,000 currently certified nurses and provides management services for the Board of Oncology Social Work Certification (BOSWC&reg;). Learn more at oncc.org. 
 
The Opportunity
The Credentialing Administrator serves as an eligibility and verification expert for ONCC certification programs. Processes a high volume of applications for all ONCC and BOSWC certification programs, including oncology nursing and related specialties, and oncology social work. The Credentialing Administrator will review and evaluate candidate eligibility in compliance with policies, established service levels, and national accreditation standards.
What You&rsquo;ll Do<div><ul><li>
Review, evaluate, and determine eligibility/compliance for credentialing program applications.</li><li>
Audit and verify documentation (e.g., transcripts, continuing education, practice hours, job descriptions, learning plans and licenses) to ensure program integrity.</li><li>
Coordinate BOSWC application review with volunteer reviewers and ensure timely, well-documented decisions, and provide BOSWC program support.</li><li>
Provide customer support via phone/email on eligibility and policies; provide Tier 1 technical support for credentialing systems and vendor sites.</li><li>
Support the Director of Operations and Operations Team with administrative and customer support duties as needed.</li><li>
Demonstrate and support a culture of diversity, equity, inclusion, and connection.</li></ul></div>
What You Bring 
Required<div><ul><li>
Bachelor&rsquo;s degree in business administration, business management, communications, or related field.</li><li>
3&ndash;5 years&rsquo; experience in a customer relations representative or credentialing role.</li><li>
Strong knowledge of Microsoft Office (e.g., Excel, Word) and certification management/reporting software.</li><li>
Strong knowledge of credentialing management systems.</li><li>
Experience applying/enforcing certification program requirements.</li><li>
Proven ability to make effective independent decisions.</li><li>
Working knowledge of HIPAA and FERPA compliance/violations.</li><li>
Excellent organizational and time management skills; ability to write, read, and interpret SOPs, transcripts, and similar documentation.</li></ul></div>
Preferred<div><ul><li>
3 &ndash; 5 years working in credentialing, preferably in nursing or other healthcare field (An equivalent combination of education, training, and experience may be considered in lieu of degree requirements).</li><li>
Working knowledge of video conferencing software (e.g., Zoom).</li><li>
Knowledge of oncology nursing and/or oncology social work terminology, degrees, licensure, continuing education accreditation and testing accommodations.</li><li>
Institute for Credentialing Excellence Credentialing Specialist Certificate (held or gained within the first 24 months in the position).</li></ul></div>
Work Environment &amp; Travel<div><ul><li>
Full-time, remote (work-from-home) position.</li><li>
Occasional travel to ONCC offices in Pittsburgh, PA throughout the year is required.</li></ul></div>
Compensation &amp; Benefits
We use a market-based approach to compensation, considering experience, qualifications, and market conditions.
Anticipated Pay Range: $50,999 - $61,199 annually
Benefits include:<div><ul><li>
Tuition Reimbursement/Continuing Education Allowance</li><li>
Flexible schedules</li><li>
Generous paid time off</li><li>
Health and dental benefits</li><li>
Computer Purchase Loan Program</li><li>
Pet Insurance</li><li>
Retirement Savings Plan (401k) after 30 days</li><li>
Travel opportunities</li></ul></div>
Our Commitment to Inclusion
ONS is an Equal Opportunity and Affirmative Action Employer. We value diversity, equity, and inclusion and are committed to building a workplace that reflects a broad range of backgrounds, perspectives, and experiences. All qualified applicants are encouraged to apply.</div>

Credentialing Administrator

UC Irvine Health

<div>Overview:
<div>
UCI Health is the clinical enterprise of the University of California, Irvine, and the only academic health system based in Orange County. UCI Health is comprised of its main campus, UCI Medical Center, a 459-bed, acute care hospital in in Orange, Calif., four hospitals and affiliated physicians of the UCI Health Community Network in Orange and Los Angeles counties and ambulatory care centers across the region. Listed among America&rsquo;s Best Hospitals by U.S. News &amp; World Report for 23 consecutive years, UCI Medical Center provides tertiary and quaternary care and is home to Orange County&rsquo;s only National Cancer Institute-designated comprehensive cancer center, high-risk perinatal/neonatal program and American College of Surgeons-verified Level I adult and Level II pediatric trauma center, gold level 1 geriatric emergency department and regional burn center. UCI Health serves a region of nearly 4 million people in Orange County, western Riverside County and southeast Los Angeles County.</div><div>
To learn more about UCI Health, visit www.ucihealth.org.</div>
Responsibilities: Position Summary:
Incumbent is an advanced technical professional who functions with minimal supervision applying extensive knowledge and expertise as the person with overall system-wide responsibility for the credentialing data base (MD currently Staff). The Senior Credentialing Data Systems Specialist ensures the credentialing data system is optimized and standardized for all hospitals and the centralized credentials verification organization (CVO) and will problem solve, formulate strategies in unique and complex situations, create and administer policies, processes, and resources designed to ensure the accuracy and integrity of provider and credentialing data. The Senior Credentialing Data Systems Specialist serves as an essential link and resource between senior management, the medical staff offices (MSO) and CVO related to training, access, data entry, reporting, analysis, etc., of the data maintained in the credentialing data systems.
Qualifications: Required Qualifications: 
<ul><li>
Must possess the skill, knowledge and abilities essential to the successful performance of assigned duties
</li></ul><ul><li>Must demonstrate customer service skills appropriate to the job
</li></ul><ul><li>Minimum of five (5) years in the overall field with expertise in specific areas, including credentialing, privileging, formulating strategies, and administering policies and processes
</li></ul><ul><li>Knowledge of FPPE/proctoring processes and procedures
</li></ul><ul><li>Excellent verbal and written English communication skills
</li></ul><ul><li>Discretion and judgment in the handling of confidential and/or sensitive information
</li></ul><ul><li>Demonstrated skill and ability to independently set and meet deadlines, multi-task, and effectively manage competing priorities
</li></ul><ul><li>Demonstrated advanced skill and proficiency in MS Office Suite (Outlook, Word, Excel, PowerPoint, SharePoint)
</li></ul><ul><li>Demonstrated advanced knowledge in data analysis, research and reporting, particularly with respect to confidentiality and compliance
</li></ul><ul><li>Demonstrated ability to apply sound judgment and formulate strategies in ambiguous situations and effectively manage change
</li></ul><ul><li>Demonstrated ability to apply knowledge and recommend viable solutions for complex situations
</li></ul><ul><li>Current NAMSS certification as CPCS and/or CPMSM or achievement of certification within a year
</li></ul><ul><li>Certification of becoming certified by the vendor in the use of the software (MDStaff)
</li></ul><ul><li>Bachelor's degree in related area and / or equivalent experience / training
</li></ul><ul><li>Advanced knowledge of Joint Commission, CMS Conditions of Participations, and NCQA and Title 22 accreditation standards and regulations
</li></ul><ul><li>Advanced knowledge and expertise in medical staff credentialing and privileging processes and procedures
</li></ul><ul><li>Advanced analytical, critical thinking, organizational, and project management skills
</li></ul><ul><li>Ability to maintain professional demeanor and poise while working under pressure, meeting deadlines, and managing changing priorities
</li></ul><ul><li>Ability to maintain a work pace appropriate to the workload
</li></ul><ul><li>Ability to complete job responsibilities with a high degree of accuracy under minimum supervision
</li></ul> 
Preferred Qualifications: 
<ul><li>
Minimum of two (2) years data management experience</li></ul>
<ul><li>Knowledge of university and medical center organizations, policies, procedures, and forms</li></ul>
<ul><li>Experience with MD-Staff Credentialing Database Software</li></ul>
<ul><li>Dual NAMSS certification as CPMSM and CPCS</li></ul> 
 
Total Rewards
We offer a wealth of benefits to make working at UCI even more rewarding. These benefits may include medical insurance, sick and vacation time, retirement savings plans, and access to a number of discounts and perks. Please utilize the links listed here to learn more about our compensation practices and benefits.

Conditions of Employment: 
The University of California, Irvine (UCI) seeks to provide a safe and healthy environment for the entire UCI community. As part of this commitment, all applicants who accept an offer of employment must comply with the following conditions of employment:<ul><li>
Background Check and Live Scan</li><li>
Employment Misconduct*</li><li>
Legal Right to Work in the United States</li><li>
Vaccination Policies</li><li>
Smoking and Tobacco Policy</li><li>
Drug Free Environment</li></ul><ul><li>Misconduct Disclosure Requirement: As a condition of employment, the final candidate who accepts a conditional offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; received notice of any allegations or are currently the subject of any administrative or disciplinary proceedings involving misconduct; have left a position after receiving notice of allegations or while under investigation in an administrative or disciplinary proceeding involving misconduct; or have filed an appeal of a finding of misconduct with a previous employer.
</li></ul>The following additional conditions may apply, some of which are dependent upon business unit or job specific requirements.<ul><li>
California Child Abuse and Neglect Reporting Act</li><li>
E-Verify</li><li>
Pre-Placement Health Evaluation</li></ul>
Details of each policy may be reviewed by visiting the following page: https://hr.uci.edu/new-hire/conditions-of-employment.php 

Closing Statement: 
The University of California is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected categories covered by the UC Anti-Discrimination Policy.
 
 
We are committed to attracting and retaining a diverse workforce along with honoring unique experiences, perspectives, and identities. Together, our community strives to create and maintain working and learning environments that are inclusive, equitable, and welcoming.
 
 
UCI provides reasonable accommodations for applicants with disabilities upon request. For more information, please contact UCI's Employee Experience Center (EEC) at eec@uci.edu or at (949) 824-0500, Monday - Friday from 8:30 a.m. - 5:00 p.m.</div>

Senior Credentialing Data Systems Specialist - Medical Staff Administration - FT Days

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Credentialing Specialist

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Credentialing Specialist

Credentialing & Provider Enrollments Executive-Medical Billing

Credentialing Administrator

Senior Credentialing Data Systems Specialist - Medical Staff Administration - FT Days