Healthcare Credentialing Specialist

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🔥 2 minutes ago

🇺🇸 United States – Remote

💵 $65k - $80k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

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FP&C

WebsiteLinkedInAll Job Openings

- employees

Founded 2018

💼 Consulting

💸 Finance

🤝 B2B

Consulting • Finance • B2B

FP&C is a business consulting firm specializing in corporate finance, accounting, auditing, and statutory financial oversight (revisoría fiscal). The company provides financial advisory, accounting, and assurance services to corporate clients, helping with corporate finance transactions, financial reporting, audit compliance, and regulatory oversight.

📋 Description

• Manage an individual caseload of initial credentialing and recredentialing files from application intake through submission for review • Provide day-to-day oversight of credentialing workflows and processes • Coordinate priorities and help address backlogs and processing delays • Review and audit credentialing packets for accuracy, completeness, consistency, and compliance • Perform and document primary source verification of provider qualifications, including licensure, education, training, and certifications • Identify documentation gaps and discrepancies, obtain missing information, and maintain follow-up records • Complete required background and exclusion checks, document findings, and escalate adverse information or exceptions • Monitor credentialing progress, turnaround times, and quality standards • Communicate workload concerns and deadline risks • Maintain accurate credentialing databases and organized, audit-ready files • Monitor expiring credentials and recredentialing deadlines, initiating follow-up early • Provide guidance and support to credentialing staff and stakeholders • Assist with staff onboarding and training • Identify recurring errors and process weaknesses; recommend and implement approved improvements • Prepare status reports, support audits, and protect confidential provider and organizational information

🎯 Requirements

• Minimum of five years of healthcare provider credentialing experience, including initial credentialing, recredentialing, and primary source verification • Experience providing credentialing oversight, auditing, or quality assurance while maintaining hands-on responsibility for credentialing work • Experience coordinating credentialing processes or implementing process improvements • Experience reviewing work prepared by others, resolving complex documentation issues, and meeting established turnaround times • Knowledge of CAQH, NCQA, URAC, and government healthcare programs is preferred • TRICARE credentialing experience is a plus, but is not required • Meticulous attention to detail • Strong knowledge of provider credentialing processes, documentation requirements, and verification methods • Ability to interpret and apply applicable credentialing requirements and client and program procedures • Strong analytical, organizational, and problem-solving skills • Ability to balance an individual caseload with workflow oversight, quality reviews, and timely follow-through on team priorities • Ability to remain composed, exercise sound judgment, and communicate professionally when managing urgent requests, competing deadlines, and changing priorities • Clear written and verbal communication skills, including the ability to explain requirements, provide constructive feedback, and guide colleagues and stakeholders • Ability to resolve issues within delegated authority and escalate matters requiring management review or credentialing decisions • Proficiency with credentialing databases, Microsoft Office applications, and electronic records • Discretion and sound judgment when handling sensitive and confidential information • Consistent, full-time availability Monday through Friday, eight hours per day • Reliable internet access and a home office setup conducive to focused computer-based work

🏖️ Benefits

• Health, Dental and Vision Insurance • Group Life Insurance • Short Term Disability Insurance • Long-Term Disability Insurance • 401K with company match • Paid Time Off and Holidays • Supplemental Benefits • Remote/home office work environment

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