Offer summary

Qualifications:

Minimum of 3 years of credentialing experience in a U.S. healthcare setting., In-depth knowledge of credentialing processes and compliance regulations, especially Medicare CPT., Familiarity with CAQH, PECOS, and NPPES systems, and experience with both Nurse Practitioners and Doctors credentialing., Strong organizational skills and proficiency in Microsoft Office Suite and credentialing software..

Key responsibilities:

Manage the credentialing, re-credentialing, and enrollment processes for healthcare providers.

Complete and submit applications for provider enrollment with various payers including Medicare and Medicaid.

Perform primary source verifications and maintain accurate records in credentialing databases.

Serve as a liaison between providers and payers to resolve credentialing-related issues promptly.

Job description

#1 PH Workforce Delivering to the US.

MedCore Solutions is expanding and we are looking for an experienced and detail-oriented Credentialing Specialist to manage the end-to-end credentialing process for healthcare providers across various payers and networks. The ideal candidate will have in-depth knowledge of U.S. healthcare credentialing requirements and processes, with specific experience in Medicare CPT credentialing. This role ensures that all providers are properly enrolled and maintain active status with insurance networks, including Medicare, Medicaid, and commercial payers.

Who We Are

MedCore Solutions (MCS) is the leading provider of healthcare administration services, specializing in areas such as medical billing, credentialing, insurance verification, and virtual staffing. We aim to connect top talent with robust and fulfilling career opportunities in the ever-evolving healthcare landscape.

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.

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

Other details:

Start Date: ASAP

Schedule: TBD

Days Off: Saturday & Sunday

Time zone: Pacific Standard Time/Eastern Standard Time

Benefits

Our Commitment to delivering high-quality results for our clients and the only way to do that is ensuring a rewarding, respectful and productive experience for our employees. We hold the same values for both our customers and our employees.