Healthcare Representative - US Provider Credentialer (Remote)

Provider Credentialer – Remote

We are seeking an experienced and detail-oriented Provider Credentialer to support our healthcare group practice. This role is crucial in ensuring that our healthcare professionals are properly credentialed with insurance companies, regulatory bodies, and other relevant organizations.

The ideal candidate has experience in provider credentialing, understanding insurance panel complexities, and knowledge of relevant regulations.

Key Responsibilities
Manage the full credentialing lifecycle for healthcare providers, including initial credentialing, re-credentialing, and privileging.
Verify and maintain accurate records for provider qualifications (licensure, certifications, malpractice insurance, and continuing education).
Coordinate with providers to collect necessary documentation and ensure timely submission to insurance companies and credentialing entities.
Work directly with insurance companies and CAQH to facilitate provider enrollment and network participation.
Ensure compliance with NCQA, URAC, and other accreditation standards.
Communicate with providers regarding credentialing status, documentation needs, and follow-ups.
Stay updated on regulations, payer requirements, and evolving credentialing standards.
Resolve credentialing-related issues, discrepancies, and disputes to avoid billing disruptions.
Track expiration dates for licenses, certifications, and insurance contracts, ensuring timely re-credentialing.
Support audits and internal reviews to maintain full compliance.
Ensure confidentiality and security of provider information per HIPAA and privacy laws.

Qualifications

HIPAA Certified.
Strong organizational skills with the ability to manage multiple tasks and meet deadlines.
Excellent communication skills for interacting with providers, insurance companies, and internal teams.
2-5 years of experience in provider credentialing for healthcare professionals (doctors, nurses, specialists, etc.).
Knowledge of insurance credentialing and payer requirements.
Familiarity with healthcare-related credentials (MD, RN, LCSW, PhD/PsyD, etc.).
Strong understanding of HIPAA, Medicare, and compliance regulations.
Experience with AHCA, NCQA, URAC, and healthcare accreditation standards.
Proficiency in credentialing software and provider databases.
High attention to detail, accuracy, and organization.
Self-driven go-getter with the ability to work independently and take initiative with minimal supervision.

Preferred Skills
Certified Provider Credentialing Specialist (CPCS) or other credentialing certifications.
Experience working within a healthcare group practice or similar clinical settings.
Experience with insurance companies like Aetna, BCBS, Cigna, Humana, Tricare, and UnitedHealthcare for healthcare providers.
Knowledge of MHPAEA (Mental Health Parity and Addiction Equity Act) and healthcare regulations.

Why Join Us?
Work remotely with a flexible schedule.

Rate starts at $4.00 - $4.50 per hour, based on experience.
Opportunities for career growth in a growing healthcare organization.
Collaborative and supportive team environment.

Technical Requirements
Dual-monitor setup (PC/Laptop) with backup device (MacBooks are not allowed).
Stable and fast internet connection (minimum 50 Mbps or ability to upgrade). Must have a main ISP and a backup ISP (prepaid wifi/pocket wifi acceptable).
Power backup (UPS, generator, backup laptop, etc.).

Priority Reminder
At this time, we are prioritizing unemployed applicants or those who are ready to start immediately. If you are currently employed and have not yet rendered your notice, we kindly ask that you apply once your schedule fully accommodates the role.

If you're ready to take on a challenging and rewarding role in provider credentialing, we encourage you to apply!