Credentialing Senior Representative - MD Live - Remote

About the role

The Provider Credentialing Senior Representative is responsible for executing core credentialing and provider data management functions to ensure compliance with regulatory and organizational standards. This role supports the full credentialing lifecycle, including initial credentialing, re-credentialing, and privileging of providers, while maintaining accurate records and delivering high-quality service to internal and external stakeholders.

Responsibilities

• Perform delegated credentialing activities, including initial credentialing, re-credentialing, and privileging in accordance with established policies and procedures
• Process provider applications and re-applications, including distribution, review for completeness, and system data entry
• Verify provider credentials, including licenses, certifications, and other regulatory requirements
• Maintain accurate provider profiles within credentialing and provider management systems
• Prepare credentialing files and documentation for committee review, ensuring completeness and compliance
• Manage incoming communications in the Credentialing and Verifications and Government Programs inbox, ensuring timely and accurate responses
• Respond to provider inquiries related to credentialing status, liability coverage, licensure updates, and demographic/profile changes
• Process employment and credentialing verification requests in a timely manner
• Triage and route incoming requests and inquiries to appropriate internal departments for resolution
• Support Medicaid provider enrollment activities, including maintaining accurate enrollment records and ensuring proper state linkages
• Conduct routine audits and assist with departmental projects and process improvement initiatives
• Identify and proactively address potential issues, demonstrating forward planning and problem-solving capabilities
• Resolve non-routine or escalated issues and provide guidance to junior team members as needed

Requirements

2+ years of experience in provider credentialing, provider enrollment, or healthcare operations (preferred)

Knowledge of credentialing standards, regulatory requirements, and verification processes

Experience with Medicaid enrollment processes and multi-state provider management (preferred)

Strong attention to detail with the ability to manage multiple priorities in a fast-paced environment

Excellent written and verbal communication skills

Ability to work independently while collaborating cross-functionally

Proficiency with credentialing systems, databases, and Microsoft Office tools

Organizational and time management skills

Problem-solving and critical thinking

Attention to detail and accuracy

Customer Service Orientation

Process improvement mindset

Qualifications

Education and Experience

• 2+ years of experience in provider credentialing, provider enrollment, or healthcare operations (preferred)
• Knowledge of credentialing standards, regulatory requirements, and verification processes
• Experience with Medicaid enrollment processes and multi-state provider management (preferred)