Job Description

Healthcare Credentialing Specialist

Independent Contractor [Business Support VA/Junior -Senior Level] (Remote).

20four7VA is looking for dedicated offshore independent contractors to provide remote services to clients globally, with a primary focus on developed markets like the United States, the United Kingdom, Canada, and Australia.

The Healthcare Credentialing Specialist is a key role responsible for managing the credentialing and re-credentialing processes for healthcare providers, ensuring compliance with state, federal, and payer-specific requirements. This position is essential for ensuring that providers are effectively enrolled, credentialed, and eligible for reimbursement, primarily focusing on California and Nevada.

As a contractor, you will perform tasks that include:

• Provider Enrollment & Credentialing: Complete and submit credentialing applications for Medicare, Medicaid, and commercial payers. Verify provider credentials including education, training, licensure, and board certifications. Maintain and update provider information in relevant databases and track application status, ensuring timely follow-up on any issues or missing documentation.
• Compliance & Regulatory Requirements: Ensure adherence to federal, state, and payer-specific credentialing standards. Monitor expirables (licenses, DEA, malpractice) and send renewal reminders. Keep accurate records in line with HIPAA and company policies while staying informed on regulatory changes.
• Communication & Coordination: Liaise with providers, practice managers, and payers to gather necessary documentation and resolve credentialing issues. Provide regular updates on provider status and assist with audits related to credentialing compliance.

Each engagement is governed by an independent contractor agreement, and successful candidates will need to:

• Exhibit strong organizational skills and attention to detail.
• Demonstrate excellent communication and follow-up abilities.
• Be proficient in Microsoft Office and credentialing software.
• Manage multiple applications and deadlines simultaneously.
• Show strong analytical thinking and problem-solving skills.

Requirements include a minimum of 2 years of experience in credentialing or provider enrollment within a healthcare setting, with familiarity in payer requirements for California and Nevada. Experience with Medicare (PECOS), NPPES, and CAQH systems is essential. Knowledge of NCQA, CMS, and Joint Commission standards is preferred. Certifications such as Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) are a plus, but not mandatory.

Contracted Hours: 40 hours/week, Monday through Friday, from 8 AM to 5 PM PST. The company will strive to align your schedule with client preferences, but availability may vary based on time zones and contracted hours.

Contractors will operate under a Master Services Agreement and a Statement of Work; this engagement does not constitute employment. Compensation is processed through 20four7VA as per the engagement terms. By applying, you acknowledge that this is an independent contractor opportunity, not an employment offer. Applications will be evaluated based on alignment with client needs and qualifications. If selected, a member of our team will reach out to discuss the next steps.

We eagerly anticipate reviewing your application and potentially collaborating with you on future projects!

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