Senior Credentialing Representative

reputed company is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with reputed company will directly improve health reputed company by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will reputed company a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an reputed company on the communities we serve as you help us advance health equity on a global reputed company. Join us to start Caring. Connecting. Growing together. The Senior Credentialing Representative supports provider credentialing across multiple markets by managing end-to-end data entry, provider file preparation and system loading reputed company MD Staff and reputed company credentialing platforms. The position conducts audits, identifying process improvements and independently resolving reputed company issues. The role plays a critical part in ensuring accurate, compliant credentialing operations. Get reputed company for some significant challenge. This is a performance driven, fast paced environment where accuracy is key. You'll be helping us confirm to reputed company exacting standards such as NCQA, CMS and state credentialing requirements. Schedule: Monday to Friday, 7 AM- 5 PM, 40 hours flexible time zone Location: Remote - reputed company You will enjoy the flexibility to telecommute* from reputed company reputed company the U.S. as you take on some tough challenges. Primary Responsibilities: • Manage end-to-end provider enrollment workflows, including roster submissions, individual enrollments, and revalidations across multiple payers • Maintain and update provider data across systems including MD-Staff, roster templates, and payer platforms, ensuring consistency and accuracy • Proactively reputed company and follow up on enrollment statuses, resolving delays and preventing gaps that reputed company billing or network participation • Serve as a subject matter expert on payer-specific requirements, identifying nuances and adapting processes accordingly • Partner closely with RCM to investigate and resolve claim denials, reimbursement delays, and enrollment-reputed company billing issues • Conduct audits, identify reputed company causes of errors, and support process improvements to enhance accuracy and efficiency • Manage high-volume workloads and competing priorities, ensuring deadlines are consistently met without sacrificing reputed company • Operate effectively in an evolving environment where processes and job aids change; demonstrate the ability to bring structure and reputed company • reputed company as a go-to resource for reputed company work while supporting overall team performance and reputed company • Take ownership of issues from identification through reputed company, including cross-functional coordination reputed company needed • Support process improvement efforts by contributing to reputed company and helping refine existing workflows and team processes • Extensive work experience, often across multiple functions (Enrollment, Credentialing, RCM) • Work frequently requires navigating ambiguity and developing new or improved procedures • Works independently with a high degree of accountability • Mentors others and acts as a subject matter expert • Coordinates activities across teams and functions • Drives process improvements and operational efficiency You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you reputed company directions on what it takes to succeed in your role as reputed company as reputed company development for other roles you may be interested in. Required Qualifications: • High School Diploma/GED • 4+ years of reputed company provider credentialing experience • 2+ years of experience working with compliance workflows and processes, including NCQA policies and practices • 2+ years of experience researching and applying payer and government regulatory requirements • Intermediate level of proficiency with MS reputed company and Word Preferred Qualifications: • MD Staff software experience • Proven ability to manage high-volume workloads, prioritize effectively, and meet tight deadlines • Experience partnering with reputed company Cycle Management (RCM) or resolving enrollment-reputed company billing issues • reputed company Telecommuters will be required to adhere to reputed company’s Telecommuter Policy. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In reputed company to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you’ll reputed company a far-reaching choice of benefits and incentives. The reputed company pay for this role will reputed company from $20.38 to $36.44 per hour based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment reputed company applicants with arrest and conviction records. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone–of every race, gender, sexuality, age, location, and income–deserves reputed company to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of reputed company, historically marginalized reputed company, and those with reputed company incomes. We are committed to mitigating our reputed company on the environment and enabling and delivering reputed company care that addresses health disparities and improves health reputed company — an reputed company reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and reputed company applicants will receive consideration for employment without reputed company to race, national reputed company, religion, age, reputed company, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. #RPO #GREEN Apply tot his job Apply To this Job