Medical Credentialing Specialist 2 + years experience required

Job Overview
We are seeking a detail-oriented and organized Credentialing Specialist to join our healthcare team. The ideal candidate will be responsible for managing the credentialing and re-credentialing processes for healthcare providers, ensuring compliance with industry standards and regulations. This role requires a strong understanding of managed care, medical terminology, and NCQA standards to maintain accurate provider records and facilitate smooth credentialing workflows. The Credentialing Specialist plays a vital role in supporting our organization's commitment to quality care and regulatory compliance.

Responsibilities

• Manage the end-to-end credentialing and re-credentialing processes for healthcare providers in accordance with organizational policies and industry standards.
• Verify provider credentials, licenses, certifications, and other required documentation.
• Maintain accurate and up-to-date provider files in compliance with managed care requirements and NCQA standards.
• Collaborate with internal departments such as medical offices, compliance, and contracting to gather necessary documentation.
• Track credentialing deadlines and ensure timely completion of all required activities.
• Prepare and submit credentialing applications to various payers and accreditation bodies.
• Stay informed about changes in healthcare regulations, managed care policies, and NCQA standards that impact credentialing procedures.
• Assist with audits related to provider credentials and ensure documentation meets regulatory requirements.
• Support continuous process improvement initiatives to enhance efficiency and accuracy of credentialing workflows.

Qualifications

• Prior experience in medical office administration or healthcare credentialing is preferred.
• Strong knowledge of managed care processes, medical terminology, and NCQA standards is highly desirable.
• Excellent organizational skills with keen attention to detail to manage multiple provider files simultaneously.
• Ability to interpret healthcare regulations and ensure compliance across all credentialing activities.
• Effective communication skills for liaising with providers, payers, and internal teams.
• Proficiency in healthcare management software or credentialing databases is a plus.
• Demonstrated ability to work independently while maintaining accuracy under deadlines. This position offers an engaging opportunity to contribute to a reputable healthcare organization committed to excellence in provider credentialing and patient care quality.

Job Type: Temp-to-hire

Pay: From $21.00 per hour

Education:

• High school or equivalent (Required)

Experience:

• Credential process: 2 years (Required)
• Regulatory Compliance : 1 year (Preferred)
• HIPPA & CMS Compliance : 2 years (Required)

Location:

• McAllen, TX 78501 (Required)

Work Location: In person

Salary : $21