Specialist Healthcare
Job Description
Responsibilities
Provider Credentialing
• Manage end-to-end provider credentialing, re-credentialing, and credential
maintenance.
• Review credentialing applications for completeness, accuracy, and compliance.
• Conduct Primary Source Verification (PSV)
• Maintain complete and audit-ready credentialing files.
Provider Enrollment
• Prepare, submit, and monitor provider enrollment applications with Medicare
(PECOS), Medicaid, IHCP (Indiana Health Coverage Programs), MHS, and
commercial insurance payers.
• Track application status, resolve deficiencies, and follow up with payer
representatives until enrollment approval.
• Ensure timely completion of provider revalidation and re-enrollment activities.
Physician Onboarding
• Coordinate end-to-end physician and provider onboarding activities.
• Collect onboarding documents and ensure all credentialing and enrollment
requirements are completed before the provider’s start date.
• Collaborate with HR, Operations, Practice Managers, and providers to facilitate a
smooth onboarding experience.
System & Database Management
• Maintain accurate provider records in CAQH ProView, Symplr, Cactus, Modio,
VerityStream, MD-Staff, and payer portals.
• Update provider profiles, upload supporting documents, perform CAQH
attestations, and ensure data integrity across all credentialing systems.
Compliance & Documentation
• Ensure compliance with NCQA, CMS, URAC, The Joint Commission (TJC), and
payer-specific credentialing guidelines.
• Monitor provider licenses, DEA registrations, board certifications, malpractice
insurance, and other expiring credentials to ensure uninterrupted provider
participation.
• Prepare reports, maintain credentialing trackers, and support internal and external
audits.
Key Competencies
• Excellent verbal and written English communication skills
• Strong attention to detail and documentation accuracy
• Excellent organizational and time management skills
• Strong analytical and problem-solving abilities
• Ability to prioritize multiple tasks and meet deadlines
• Effective coordination and stakeholder management skills
• Customer-focused approach with strong interpersonal skills
• Ability to work independently in a remote environment
• High level of accountability, ownership, and confidentiality
• Strong follow-up and issue resolution skills
Qualifications
• Bachelor’s degree in healthcare administration, Life Sciences, Business
Administration, or a related field (preferred).
• Minimum 3 years of experience in US Healthcare Provider Credentialing,
Provider Enrollment, or Physician Onboarding.
• Hands-on experience with CAQH ProView, Medicare (PECOS), Medicaid, IHCP,
MHS, and commercial payer enrollment processes.
• Strong understanding of Primary Source Verification (PSV) and provider
credentialing workflows.
• Working knowledge of NCQA, CMS, URAC, and The Joint Commission (TJC)
standards.
• Experience using credentialing platforms such as CAQH, Symplr, Cactus, Modio,
VerityStream, MD-Staff, or similar systems.
• Proficiency in Microsoft Office Suite, particularly Excel, Word, and Outlook.
Are you interested in this position?
Apply by clicking on the “Apply Now” button below!
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