Remote Insurance Medical Credentialing Specialist

Job Summary:
We are looking for an experienced Insurance Medical Credentialing Specialist to join our team and take ownership of the credentialing process. This role focuses on managing credentialing accurately and efficiently, ensuring compliance and smooth operations. It requires a solid background in insurance credentialing, intake, and verification, as you will play a key role in streamlining and improving our in-house credentialing workflows.

Key Responsibilities:

• Manage the full insurance credentialing process internally, ensuring compliance with all requirements and helping transition from third-party credentialing to in-house management.
• Perform insurance intake and verification, confirming patients eligibility, benefits, and authorizations directly with insurance companies.
• Collect and accurately enter patient information, including demographics, medical history, and insurance details, into the system.
• Maintain accurate records and documentation related to credentialing and insurance verification.
• Process and track new patient referrals received by phone, email, or fax, ensuring timely follow-up.
• Communicate professionally and empathetically (Inbound and Outbound calls) with patients, providers, and insurance companies regarding procedures, appointments, insurance, and general inquiries.
• Coordinate effectively with internal teams (such as nursing, billing, and care coordination) and external providers to support smooth care delivery.
• Identify opportunities to improve credentialing workflows and administrative processes to enhance efficiency.
• Act as a liaison during the transition from third-party credentialing to in-house management.
• Uphold patient confidentiality and adhere to HIPAA and other regulatory standards in all communications and data handling.
• Perform other tasks related to the position.

Qualifications & Requirements:

• Advanced level of English (written and spoken).
• Strong communication skills in English (spoken and written) with the ability to effectively engage with cross-functional teams, internal leaders, and providers.
• Excellent interpersonal skills, with strong attention to detail and the ability to learn and adapt quickly.
• Self-motivated, proactive, solution-oriented, with a strong sense of responsibility and the ability to follow through on assigned tasks.
• Proven experience in insurance credentialing or medical credentialing specialist roles.
• Excellent organizational and follow-up abilities.
• Familiarity with healthcare paperwork and prior authorizations.
• Strong knowledge of insurance intake, verification, and credentialing procedures.
• Ability to work independently and manage multiple credentialing cases efficiently.
• Familiarity with credentialing software and databases is a plus.
• Proficiency in electronic medical records (EMR) systems is a plus.
• Knowledge of insurance verification processes (Medicare, Medicaid, private insurance).
• Proficiency in Microsoft Office 365 (Word, Excel, Outlook).
• Ability to work independently with minimal supervision.
• Must have a Windows computer (Windows 10 or newer) that is less than 4 years old.
• Two monitors and a high-speed fiber network or Starlink internet.

Compensation & Benefits:

• 100% remote work.
• Compensation in USD.
• Full-time position with 40 hours weekly.
• Great work environment with potential for growth.