Credentialing Administrator

Job Description

Description:

We are seeking a detail-oriented and experienced Credentialing Administrator to join our dermatology practice. The Credentialing Administrator will be responsible for managing and maintaining the credentialing and re-credentialing process for all healthcare providers, ensuring compliance with regulatory and insurance requirements. The ideal candidate will have a strong understanding of credentialing procedures, excellent organizational skills, and the ability to communicate effectively with providers, payers, and internal staff.Requirements:

Key Responsibilities:

Oversee and manage the credentialing and re-credentialing processes for physicians, nurse practitioners, and other healthcare providers within the practice.

Maintain up-to-date provider files, ensuring all documentation is current and compliant with federal, state, and payer-specific requirements.

Prepare and submit applications for provider enrollment with commercial and government insurance plans (Medicare, Medicaid, private insurers, etc.).

Track and monitor the status of credentialing applications, following up as needed to ensure timely approvals.

Maintain credentialing databases and software, updating records as necessary.

Coordinate with providers and practice administrators to ensure timely submission of required documentation.

Monitor and ensure compliance with regulatory bodies, such as The Joint Commission (TJC), National Committee for Quality Assurance (NCQA), and the Centers for Medicare & Medicaid Services (CMS).

Respond to inquiries regarding credentialing status and requirements.

Assist in audits and provide reports on credentialing activities as needed.

Qualifications:

Associate’s or Bachelor’s degree in healthcare administration, business administration, or a related field (preferred).

Minimum of 2-3 years of experience in medical credentialing, preferably in a Dermatology or multi-specialty practice.

Knowledge of provider enrollment procedures with Medicare, and commercial payers.

Familiarity with credentialing databases and software systems.

Strong understanding of compliance regulations and industry standards.

Excellent attention to detail and organizational skills.

Strong communication and problem-solving abilities.

Ability to work independently and manage multiple tasks efficiently.

Benefits:

Competitive salary based on experience.

Health, dental, and vision insurance.

Paid time off and holidays.

Professional development opportunities.

Retirement plan options.

If you are a highly motivated professional with a passion for ensuring provider compliance and a commitment to excellence, we invite you to apply for this position. Please submit your resume along with a cover letter.

Full-time