Credentialing Specialist (Remote)

Job Title: Credentialing Specialist (Remote)

Pay Rate: $20.00 per hour

Location: Remote (Must work Eastern Standard Time: 8:30 AM – 4:30 PM)

Job Type: Full-Time, 13-Week Contract (Potential for Full-time Conversion)

Schedule: Monday – Friday (40 hours/week)

Job Summary

We are seeking a detail-oriented and self-motivated Credentialing Specialist to manage all aspects of credentialing, re-credentialing, and privileging processes for medical providers across our continuum of care.

In this role, you will ensure providers are fully credentialed, appointed, and privileged with health plans, hospitals, and patient care facilities. You will maintain up-to-date provider data, ensure timely renewals of licenses and certifications, manage payer enrollment, and oversee credentialing requirements for contracted vendors serving our patients and participants.

Key Responsibilities

• Provider Data Management: Compile, track, and maintain accurate data, state licenses, DEA certificates, malpractice coverage, and required documents in MedTrainer and provider files.
• Credentialing & Re-Credentialing: Complete and monitor clinical provider credentialing applications, following up through completion.
• Payer Enrollment: Complete enrollment applications, generate provider rosters, and maintain organizational and provider profiles on online portals, including CAQH.
• Vendor Credentialing: Verify credentialing for all contracted vendors providing patient care across programs (e.g., Hospice, PACE, Palliative Care, Home Health, Medical Services).
• Hospital Privileges: Collaborate with Physician Services to support providers in securing and maintaining hospital privileges.
• Financial Alignment: Work closely with the finance team to identify and resolve billing or payer issues linked to provider credentialing.
• Compliance: Maintain current knowledge of accreditation, state, and federal regulatory standards governing provider credentialing.

Requirements

Required Qualifications & Experience

• Home Health & Hospice Credentialing: Direct experience with home health and hospice provider credentialing is strictly required. (Candidates with only hospital credentialing background will not be considered.)
• Software & Excel Skills: Advanced proficiency in Microsoft Excel (creating and managing worksheets, advanced formulas, etc.) and Microsoft Office Suite. High proficiency in MedTrainer is required.
• Payer Experience: Proven experience navigating Medicare and Medicaid credentialing and payer enrollment processes.
• Education:
• Associate degree (A.A.) or equivalent from a two-year college/technical school; OR
• 6 months to 1 year of directly related experience/training; OR
• An equivalent combination of education and experience.
• Licensure: Valid Driver’s License and auto insurance.

Preferred Qualifications

• 3+ years of dedicated healthcare credentialing experience.
• Certified Provider Credentialing Specialist (CPCS) certification.

Key Competencies

• Attention to Detail: Exceptional accuracy in managing sensitive provider data and complex documentation.
• Communication & Collaboration: Excellent verbal and written skills to build relationships with providers, health plans, and internal teams.
• Self-Management: High degree of accountability, dependability, and time-management skills in a remote environment.