Credentialing Specialist

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OCHIN, Inc.

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2000

💼 Consulting

🏥 Healthcare

🤝 Non-profit

Consulting • Healthcare • Non-profit

OCHIN, Inc. is a nonprofit health IT consultancy that partners with rural and community care organizations across the United States to advance equitable, whole-person care. For more than 25 years it has provided access to a shared EHR platform and integrated knowledge solutions, and it delivers Health IT, workforce training, operational/financial consulting, research, and advocacy to improve clinical quality, clinician well‑being, and sustainability for its national network of community health providers.

📋 Description

• Process initial credentialing and recredentialing applications according to regulatory requirements • Review and analyze credentialing applications and supporting documents for accuracy and completeness • Validate and verify provider credentials through appropriate sources • Identify discrepancies, conduct research and follow-up, and escalate unresolved issues • Complete payor provider enrollment and revalidations • Maintain CAQH profiles and NPPES registrations • Maintain provider data with payers and manage plan enrollment status in the credentialing system • Support OCHIN member organizations on-site for new software installations or training when required • Perform other duties as assigned

🎯 Requirements

• Minimum of three (3) years of progressive experience in Credentialing and/or Provider Enrollment • In-depth knowledge of credentialing, privileging, and provider enrollment standards, including HRSA, FTCA, TJC, and NCQA • Experience in MD-Staff preferred • Certified Provider Credentialing Specialist (CPCS) may be required or strongly preferred; certification must be through NAMSS, not AAPC • Proficiency in credentialing software and data management systems preferred • Advanced proficiency in Microsoft Office Suite, including Word, Excel, and PowerPoint, preferred • Working knowledge of Smartsheet, including data structure, formula creation, basic workflows, and automation, preferred • Proven experience in client-facing roles and ability to build relationships and communicate with diverse stakeholders preferred • Familiarity with Jira for issue tracking and task management preferred • Completion of a 50–60-minute competency assessment before the team interview • Ability to work independently and efficiently from a home office environment • High-speed internet service • Distraction-free workplace • Ability to read, speak, write, and understand English • Ability to travel nationwide as required by business needs • COVID-19 vaccination or approved medical or religious exemption as a condition of employment

🏖️ Benefits

• Generous compensation package • Healthy work-life balance • Opportunity for professional advancement • Comprehensive range of benefits • Remote work from home • COVID-19 vaccination requirement with medical or religious exemption process • Nationwide travel support for business needs, including air, vehicle, or train travel