Credentialing Specialist

Conifer Health Solutions • Dallas, TX

9d • Remote

About The Position

The Credentialing Specialist will be responsible for managing the credentialing and enrollment process for healthcare providers. This includes understanding NCQA standards, delegated credentialing, and Primary Source Verification. The role requires knowledge of health plan credentialing and enrollment, including Medicare and Medicaid. A key responsibility is preparing and updating provider CAQH applications for both new and existing providers during initial and recredentialing. The specialist will also build and maintain relationships with health plans to ensure providers are credentialed for billing across multiple specialties. Maintaining accurate credentialing databases, tracking file processes, and understanding various plan applications and internal workflows are crucial. The role demands adherence to established turn-around times and quality standards. Roster management and reporting experience are preferred.

Requirements

• Knowledge of NCQA standards, delegated credentialing, and Primary Source Verification.
• Knowledge of health plan credentialing and enrollment including Medicare and Medicaid.
• Strong Microsoft Excel skills (vlookups, pivot tables, etc.).
• Ability to travel up to 10% nationally.
• Knowledge of health plan credentialing, enrollment, and requirements.
• Knowledge of CAQH.
• Baseline knowledge of revenue cycle.
• Ability to work within a deadline-intense environment.
• Demonstrated problem-solving and customer service skills.
• Knowledge of Microsoft Word and other PC applications.
• Excellent verbal and written communication skills.

Nice To Haves

• Completion of an applicable Vocational or Technical training program.
• Minimum of two years of experience in a credentialing role or related health care environment (such as credentialing or file maintenance) or heavy customer service background.
• Understanding of Medicare and Medicaid enrollment (multiple states) as well as experience in navigating government portals.
• Roster management and reporting experience.

Responsibilities

• Prepare and/or update provider CAQH applications for newly affiliated and existing healthcare providers for initial and recredentialing activity.
• Build and maintain peer-to-peer relationships with all relevant market and national health plans.
• Establish credentialed status to facilitate billing for multiple specialties.
• Maintain and update credentialing databases completely and accurately.
• Ensure up-to-date tracking of file process.
• Ensure all workflow items are completed within the set turn-around-times, meeting quality expectations.
• Roster management and reporting.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED