Credentialing Specialist

Credentialing Specialist

Location: Remote | India, Philippines
Schedule: Monday - Friday, Eastern Time

Pay Range: $5.50 - $6.50/hour

Job Summary

As a Credentialing Specialist, you will be responsible for managing the credentialing and recredentialing processes for healthcare providers. This role ensures that all necessary licenses, certifications, and documentation are in place for providers to deliver services in compliance with regulatory and contractual obligations. The ideal candidate will have experience with healthcare credentialing, a strong understanding of healthcare regulations, and the ability to manage multiple tasks with accuracy and efficiency.

Primary Responsibilities

• Process initial credentialing and recredentialing applications for healthcare providers in accordance with organizational policies and state/federal regulations.

• Verify the credentials of healthcare providers, including education, certifications, licensure, and professional background.

• Accurately maintain provider information in the credentialing database, ensuring that all required documentation is current and complete.

• Ensure compliance with healthcare regulations, accreditation standards, and payer requirements. Stay updated on relevant laws and policies affecting credentialing.

• Serve as a liaison between providers, healthcare organizations, insurance companies (e.g., Medicare, Medicaid), and regulatory agencies to resolve any credentialing issues.

• Prepare and maintain audit files for accreditation and regulatory surveys. Generate reports related to credentialing activities as required by management.

• Identify opportunities for improving the credentialing process, including streamlining workflows and adopting best practices.

Job Requirements

Qualifications:

• Bachelor's degree in healthcare administration, business administration, or a related field (preferred) or equivalent experience.

• At least a minimum of 2-3 years of experience in credentialing, medical staff services, or healthcare administration.

• Familiarity with and knowledge of insurance companies policies (e.g., Medicare, Medicaid), healthcare credentialing processes, regulatory requirements, and compliance standards.

Technical Requirements:

• Candidates must provide their equipment and technology meeting these minimum specifications:

• Up-to-date desktop or laptop computer with at least 8GB of RAM and a modern processor (Intel i5 or equivalent)

• Windows 10 or macOS 10.15 (Catalina) or later

• High-speed internet connection with a minimum speed of 25 Mbps

• Functional headset with microphone, webcam, and reliable keyboard and mouse

• Quiet workspace devoid of distractions

• A second monitor is preferred but not required

• Emergency backup or contingency plan for technology or connectivity issues

Equal Employment Opportunity Statement

Nao Medical is an Equal Opportunity Employer. We are committed to fostering, cultivating, and preserving a culture of diversity, equity, and inclusion. We do not discriminate based on race, color, religion, creed, national origin, ancestry, sex, age, disability, marital status, sexual orientation, gender identity, genetic information, military or veteran status, or any other characteristic protected by applicable federal, state, or local laws. This policy applies to all employment terms and conditions, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

Nao Medical is dedicated to providing a work environment free from discrimination and harassment and treating all individuals with respect and dignity. Combining individuals from diverse backgrounds and experiences creates a more innovative, creative, and productive workforce.

Experience the Nao Medical difference. Join us in transforming healthcare, Nao!