Provider Credentialing Specialist

Location: Remote (U.S.)

Type: Full time Mon-Friday 9:00 a.m. to 5 p.m. EST

About the Role:

We are seeking an experienced Provider Credentialing Specialist to join our growing team. The ideal candidate will have a strong background in multi-state credentialing, with specific experience credentialing for Primary, Cardiology, Dental, and Anesthesia providers. This role requires exceptional attention to detail, accuracy, and the ability to work independently while managing multiple provider files across various payors and states.

Responsibilities:

Complete provider credentialing and recredentialing applications for multiple specialties, including Cardiology, Dental, and Anesthesia
Navigate and comply with state-specific Medicaid and Medicaid MCO credentialing requirements
Maintain accurate records of provider files, applications, and payer correspondence
Update and maintain provider information in credentialing databases such as CAQH, PECOS, NPPES, and other payor -specific platforms
Follow up with payors, providers, and internal teams to ensure timely completion of all credentialing processes
Build and Maintain relationship with Insurance representatives throughout the credentialing process to ensure up to date and timely response
Be able to Navigate through Several Different State Portals to obtain the proper information to being credentialing process or recredentialing process.
Interpret and apply plan-specific rules and state requirements for credentialing in each assigned region
Support ongoing growth—currently managing credentialing for 11 states, 26 providers, and 141 locations (and expanding)
Manage and track all work using an excel spreadsheet

Qualifications:

Minimum 5 years of experience in provider credentialing (multi-state preferred)
In-depth knowledge of CAQH, PECOS, NPPES, and commercial payor platforms
Proven experience with Medicaid and Medicaid Managed Care Organizations (MCOs)
Strong understanding of payer enrollment processes for both commercial and government plans
Excellent organizational skills and follow-up practices
Self-motivated, detail-oriented, and able to work independently
Experience with Cardiology, Dental, or Anesthesia credentialing is highly preferred
Experience using Excel and knowing how to create pivot tables and organize; track and follow up on all providers using this type of platform
CPCS (Certified Provider Credentialing Specialist) preferred but not required

Schedule & Compensation:

Full time
Competitive hourly rate based on experience
Rate: $21.00 - 23.00/ hour

How to Apply:

To apply, please submit your resume and a cover letter highlighting your relevant experience and send to: cspiegel@metacareusa.com

NOTE: YOUR APPLICATION WILL NOT BE REVIEWED WITH A RESPONSE IF, I DO NOT RECEIVE A COVER LETTER WITH YOUR RESUME UPLOADED.

IF YOU ARE NOT IN ONE OF THE 50 STATES IN THE US I WILL NOT REVIEW YOUR RESUME

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