Credentialing Specialist

Summary

Join MedCore Solutions, a leading healthcare administration services provider, as a Credentialing Specialist! Manage the end-to-end credentialing process for healthcare providers, ensuring proper enrollment and active status with various payers. You will handle initial and re-credentialing, submit applications, perform verifications, maintain accurate records, and monitor expirables. This role requires strong organizational skills, proficiency in Microsoft Office Suite and credentialing software, and in-depth knowledge of U.S. healthcare credentialing requirements. The position offers permanent work-from-home opportunities with weekend offs and a great company culture. Immediate start date.

Requirements

• Minimum of 3 years of credentialing experience within a U.S. healthcare setting
• In-depth knowledge of credentialing processes and compliance regulations
• Familiarity with optometric practices and the associated documentation requirements
• Amenable to work in a graveyard shift (US time hours)
• Demonstrated experience with Medicare CPT credentialing and payer enrollment
• Experience credentialing both Nurse Practitioners (NPs) and Doctors (MDs/DOs) for commercial and government insurance plans
• Familiarity with CAQH, PECOS, and NPPES systems
• Strong understanding of provider types, billing practices, and credentialing standards
• Exceptional organizational skills with the ability to manage multiple priorities and meet deadlines
• Proficient in Microsoft Office Suite and credentialing software (e.g., Verity, IntelliSoft, MD-Staff)

Responsibilities

• Manage initial credentialing, re-credentialing, and enrollment processes for physicians and allied health professionals
• Complete and submit applications for provider enrollment with Medicare, Medicaid, and commercial payers
• Perform primary source verifications, background checks, and licensure validations in compliance with NCQA, CMS, and payer-specific standards
• Maintain accurate and up-to-date records in credentialing databases and tracking systems
• Monitor expirables and coordinate timely renewals of licenses, certifications, and insurance
• Serve as a liaison between providers, billing teams, and payers to ensure credentialing-related issues are resolved promptly
• Ensure all credentialing files meet internal standards and external regulatory requirements
• Stay current with federal and state regulations related to provider credentialing

Preferred Qualifications

A background in insurance claim filing and processing would be a plus

Benefits

• Permanent Work From home
• Permanent Weekends Off
• Great Company Culture and No Micromanagement