Medical Credentialing Specialist - PediaStaff, Inc.

In this role, you will be responsible for overseeing the credentialing, re-credentialing, and enrollment processes for our healthcare providers, ensuring compliance with insurance networks and healthcare practices.

Responsibilities

• Oversee and manage the end-to-end provider credentialing process, ensuring providers meet federal and state regulations, as well as payer and facility requirements.
• Lead the coordination, submission, tracking, and maintenance of credentialing documents for initial enrollment, re-enrollment, and re-credentialing processes.
• Stay informed of changes in credentialing requirements, payer enrollment, and regulatory updates, proactively implementing necessary adjustments to maintain provider compliance.
• Assist in developing and updating policies, procedures, and tools to enhance the efficiency and accuracy of credentialing processes.

QUALIFICATIONS

• High school diploma or GED
• 3 years of Credentialing experience - REQUIRED
• 2 years of Provider Enrollment experience - REQUIRED
• 3 years of Medallion, Modio or comparable credentialing software experience - REQUIRED
• Multi-state credentialing experience - REQUIRED
• Working knowledge of telehealth/clinical operations and procedures is a plus!
• National company credentialing experience is a plus!
• Certified Provider Credentialing Specialist (CPCS) is a plus!
• Outstanding written and verbal communication skills
• Attentive to detail and accuracy; strong organization skills required.
• Database management skills including querying, reporting, and document generation.
• Ability to multitask and prioritize assignments
• Excellent customer service skills including strong problem solving and conflict resolution skills
• Experience with computers and Google suite programs is essential.

Work Location: Remote
Job type: Full-time, Part-time, Contract

Work Environment:

This is a fully remote position that offers flexibility in the work location.  The role requires reliable internet access and time management in a self-directed work setting. While this position offers autonomy, it requires regular collaboration and communication through virtual meetings, email, and project management tools.

Benefits:

• Medical (PPO, HMO, HDHP), dental and vision
• FSA administration
• Life Insurance
• Short/long-term disability
• Employee Assistance Program (EAP)
• Paid time off and holidays
• 401K

We are an Equal Opportunity Employer - We celebrate diversity and believe it is the key to creating vibrant, healthy communities! We encourage applicants from all cultures, races, colors, religions, sexes, national or regional origins, ages, disability status, sexual orientation, gender identity, military, protected veteran status, or other status protected by law.

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