Job Description

Position Summary

Join our dynamic team as a Credentialing Compliance Specialist, where you will be essential in managing all facets of credentialing for CPa Medical Billing. This role operates on a full-time remote basis, with consistency in the Eastern Time Zone, allowing for a balanced work-life integration.

Job Type: Full-time

Pay: $19.00 - $25.00 per hour

Benefits:

• 401(k) with matching
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Generous paid time off
• Referral program
• Vision insurance

Schedule: Monday to Friday

Responsibilities

• Accurately complete credentialing and re-credentialing applications for physicians and ancillary providers, working with third-party payers and governmental programs (Medicare and Medicaid).
• Maintain and update the Council for Affordable Quality Healthcare (CAQH) profiles for all providers.
• Ensure comprehensive credentialing data is on file for enrollment and contracting purposes.
• Keep electronic provider credentialing files organized and up to date.
• Utilize and maintain the credentialing software with current information.
• Proactively contact insurance carriers to resolve any outstanding applications or items.
• Address issues related to provider participation efficiently.
• Respond promptly to inquiries from participating physicians, staff, hospitals, and managed care companies while maintaining professionalism.
• Uphold strict confidentiality regarding all matters related to provider credentials.
• Effectively communicate client or enrollment issues to management in a timely manner.
• Be prepared to assist on various projects as directed by the Credentialing Manager.
• Perform additional duties as needed.

Qualifications

Education: High school diploma or GED equivalent.

Experience: 3-5 years of relevant healthcare experience, with specialized skills in Credentialing. Proficiency in Windows applications and Microsoft Office (Word, Outlook, Excel) is essential. Excellent communication skills—both verbal and written—are required, alongside strong problem-solving abilities with minimal supervision.

Language Skills: Proficiency in English; bilingual skills are a plus.

Mathematical Skills: Basic math skills are required.

Reasoning Ability: Strong critical thinking and analytical skills are necessary for success in this role.

The ideal candidate will have:

• Exceptional customer service and interpersonal skills.
• Ability to work independently as well as collaboratively in a team setting.
• Outstanding organizational and time management skills to effectively prioritize and meet deadlines.
• A keen attention to detail and quality.
• Strong proficiency with Microsoft Office Suite (Word and Outlook); Excel skills are preferred.

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