Credentialing Specialist

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QualDerm Partners

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

💼 Consulting

⚖️ Legal

🏥 Healthcare

💰 Venture Round on 2016-02

Consulting • Legal • Healthcare

QualDerm Partners is a comprehensive network dedicated to supporting high-quality dermatology practices and skin care experts across the United States. It empowers dermatologists with management support, access to capital, and strategic alliances to ensure long-term growth and operational efficiency. By facilitating partnerships and enhancing practice infrastructure, QualDerm enables dermatologists to concentrate on delivering outstanding patient care, particularly in fields such as skin cancer care, aesthetics, and cosmetic surgery. QualDerm Partners operates with a culture of quality and innovation, supporting over 158 practices and serving more than 120,000 patients monthly. Their commitment to maintaining physician autonomy while providing robust business support sets them apart in the healthcare sector.

📋 Description

• Oversee provider credentialing and payer enrollment with third-party payers and hospital/health system partners for an assigned region • Assure compliance with health plan requirements related to provider certification and credentialing • Meet routinely with regional operational leadership to ensure timely onboarding of new providers and completion of credentialing needs • Maintain up-to-date provider data in credentialing databases and online systems • Ensure timely renewal of licenses, certifications, and credentialing • Maintain confidentiality of provider information • Assist in managing information flow between payers, contracted PHOs, ACOs, and other QualDerm networks • Coordinate and prepare management reports for assigned regions • Manage process and quality improvement efforts related to payer enrollment, data entry, credentialing committees, and credentialing/enrollment activities • Participate in training new Credentialing & Enrollment team members

🎯 Requirements

• Bachelor’s degree in related field preferred • Minimum of three (3) years’ experience in managed care credentialing or medical staff service setting required • National or multi-state credentialing experience preferred • Demonstrated skills in analysis, problem solving, and resolution • Ability to communicate appropriately and effectively with practitioners and providers, including sensitive and confidential information • Strong knowledge of NCQA, Joint Commission, URAC, CMS, and state laws and regulations related to credentialing QualDerm providers • Ability to prioritize and meet ongoing deadlines for timely completion • Ability to function independently in a matrix environment • Must be currently authorized to work in the United States on a full-time basis

🏖️ Benefits

• Competitive Pay – Attractive compensation to reward your hard work • Comprehensive Health Coverage – Includes Medical, Dental, and Vision plans to keep you covered • Generous 401(k) Plan – Company matches 100% of the first 3%, plus 50% of the next 2%, with immediate vesting • Paid Time Off (PTO) – Accrue PTO from day one, plus enjoy 6 paid holidays and 2 floating holidays each year • Company-Paid Life Insurance – Basic life coverage, with the option for additional plans • Disability Protection – Short-term and long-term disability coverage • Additional Wellness Plans – Accident, critical illness, and identity theft protection plans • Employee Assistance Program (EAP) • Exclusive Employee Discounts • Referral Bonus Program