Certified Provider Credentialing Specialist (CPCS) - #26-13780

Duration: 12 months contract
 
Job Description:

• We are seeking an experienced Certified Provider Credentialing Specialist (CPCS) to support a growing Telehealth organization. This role is responsible for provider credentialing, payer enrollment, licensing administration, compliance monitoring, and quality program support. The ideal candidate will possess knowledge of healthcare credentialing regulations, provider enrollment processes, and quality compliance standards.

• Credentialing & Provider Enrollment
  • Manage end-to-end provider credentialing and re-credentialing activities in accordance with NCQA, URAC, CMS, and payer-specific requirements.
  • Verify provider credentials, including licensure, DEA registrations, board certifications, malpractice coverage, education, training, and work history through primary source verification.
  • Maintain credentialing files and ensure accurate, timely processing of applications and renewals
• Payer Enrollment & Provider Data Management
  • Complete provider enrollment, revalidation, and credentialing applications with commercial and government payers.
  • Maintain and update CAQH profiles, NPPES records, and payer rosters.
  • Track enrollment status and resolve enrollment-related issues with health plans and regulatory agencies.
  • Ensure provider demographic and credentialing data remain accurate across all systems.
  • Provide administrative support for provider licensing and Continuing Medical Education (CME) activities.
  • Support on credentialing regulations, enrollment requirements, and industry best practices.

• Minimum 5 years of progressive experience in healthcare provider credentialing and payer enrollment.
• Certified Provider Credentialing Specialist (CPCS)
• Strong working knowledge of provider credentialing, privileging, payer enrollment, and recredentialing processes.
• Experience/knowledge with CAQH, NPPES, provider data management, and payer enrollment systems,  NCQA, URAC, CMS, and other healthcare regulatory standards.
• Experience supporting telehealth, multi-state provider networks, or healthcare organizations operating nationally.
• Experience with credentialing databases, reporting tools, and compliance management systems.

• American Academy of Professional Coders (AAPC), or National Association Medical Staff Services (NAMSS)

• Provider Credentialing & Recredentialing

• Payer Enrollment & Revalidation
• CAQH Administration
• NPPES Management
• Provider Data Management
• Credential Verification
• Regulatory Compliance (NCQA, CMS, URAC)
• Quality Audits & Reporting
• Licensing & CME Administration
• Healthcare Operations
• Telehealth Provider Support

• Bachelor’s degree preferred.

 
About US Tech Solutions:
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com.
 
US Tech Solutions is an Equal Opportunity Employer.  All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
 
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