[Hiring] Credentialing Specialist @QualDerm Partners

Role Description

The Credentialing Specialist is responsible for overseeing all aspects of the credentialing, re-credentialing, payer enrollment, and privileging processes for all providers in an assigned region. Key responsibilities include:

• Overseeing all aspects of Provider Credentialing and Payer Enrollment with third-party payers and hospital/health system partners for the assigned region.
• Assuring compliance with all health plan requirements related to provider certification and credentialing.
• Meeting with assigned region operational leadership on a routine basis to ensure timely onboarding of new providers and that all credentialing needs are met.
• Managing processes that maintain up-to-date data for each provider in credentialing databases and online systems.
• Ensuring timely renewal of licenses, certifications, and credentialing.
• Maintaining confidentiality of provider information.
• Assisting in managing the flow of information between payers, contracted PHOs, ACOs, and other QualDerm networks.
• Coordinating and preparing management reports for assigned regions.
• Managing continual process and quality improvement efforts related to payer enrollment, data entry, credentialing committees, and all aspects related to credentialing & enrollment.
• Participating in the training of new Credentialing & Enrollment team members.

Qualifications

• Bachelor’s degree in a related field preferred.
• Minimum of three (3) years’ experience in managed care credentialing or medical staff service setting required.
• National or multi-state credentialing experience preferred.
• Demonstrated skills in analysis, problem-solving, and resolution.
• Ability to communicate appropriately and effectively with practitioners and providers, including sensitive and confidential information.
• Strong knowledge of NCQA, Joint Commission, URAC, CMS, and State Laws and regulations as they pertain to the credentialing of QualDerm providers.
• Ability to prioritize and meet deadlines on an ongoing basis to ensure timely completion according to process requirements.
• Must be able to function independently in a matrix environment.

Benefits

• Competitive Pay – Attractive compensation to reward your hard work.
• Comprehensive Health Coverage – Includes Medical, Dental, and Vision plans to keep you covered.
• Generous 401(k) Plan – Company matches 100% of the first 3%, plus 50% of the next 2%, with immediate vesting.
• Paid Time Off (PTO) – Accrue PTO from day one, plus enjoy 6 paid holidays and 2 floating holidays each year.
• Company-Paid Life Insurance – Peace of mind with basic life coverage, with the option for additional plans.
• Disability Protection – Short-term and long-term disability coverage to protect you in unexpected circumstances.
• Additional Wellness Plans – Accident, critical illness, and identity theft protection plans for extra security.
• Employee Assistance Program (EAP) – Access confidential support for personal or work-related challenges.
• Exclusive Employee Discounts – Save on products and services with special discounts just for you.
• Referral Bonus Program – Earn bonuses by referring qualified candidates to join the team.

Company Description

QualDerm Partners is the largest multi-state female-founded and owned dermatology network in the U.S. We are committed to bringing you the very best in comprehensive skin care so that you can achieve a confident, healthier, and more beautiful you!