Associate Credentialing Specialist

RVO Health

4d•$48,000 - $60,000•Remote

About The Position

The Credentialing Specialist verifies and maintains healthcare provider qualifications (e.g. state licenses, education verification, certifications, work history) to ensure compliance with regulatory standards, manages provider enrollment with payers, updates databases, and acts as a liaison with providers, insurance companies, and internal departments, ensuring only qualified staff can practice.

Requirements

Minimum of 3 years of experience in provider credentialing for a practice or hospital setting
Knowledge of PECOS and CAQH processes
Strong verbal and written communication skills
Critical thinking and problem-solving
Ability to multitask, manage competing priorities, and maintain accurate records

Nice To Haves

Experience supporting provider credentialing remotely in a healthcare setting.
Experience with Medallion

Responsibilities

Verification: Authenticate degrees, licenses, board certifications, and work history.
Compliance: Ensure adherence to federal, state, and organizational regulations, updating as needed.
Data Management: Maintain accurate records in credentialing software (e.g., Medallion, CAQH, PECOS) and databases, tracking expirations.
Application Processing: Prepare, submit, and follow up on initial and re-credentialing applications with insurance payers and clients.
Liaison: Communicate with providers, compliance teams, medical staff, and finance departments.
Auditing: Conduct audits and prepare reports for regulatory reviews.
Onboarding: Support timely onboarding of new providers by ensuring they are “in-network” and credentialed.
Malpractice Management: Submitting state-funded applications, as needed.
Revenue Cycle Support: Oversee the activation of credentialed providers in company EMR to ensure all elements are met for successful billable patient visit scheduling.
Other duties as assigned.