Provider Credentialing Rep

About the role

This remote position supports Department of Defense contracts and requires U.S. citizenship plus a favorably adjudicated DoD background investigation. Veterans, Reservists, Guardsmen, and military family members are encouraged to apply.

Education & Experience

• High School Diploma or GED
• 2+ years of provider credentialing experience
• 2+ years of experience working with credentialing applications and provider data management systems to support end-to-end credentialing and data workflows
• Working knowledge of URAC and/or NCQA standards, as well as VA, TRICARE, or other federal program requirements
• If supporting TRICARE contract, must be a U.S. Citizen and able to receive a favorable interim and adjudicated final Department of Defense (DoD) background investigation

Preferred:

• 3+ years of provider credentialing experience
• 3+ years of experience working with credentialing applications and provider data management systems to support end-to-end credentialing and data workflows

Responsibilities

• Ensures credentialing and certification activities adhere to regulatory requirements, accreditation criteria, federal program guidelines, and internal quality standards.
• Leads the review and evaluation of certification and credentialing processes to identify gaps, redundancies, and improvement opportunities; recommend and support implementation of process enhancements aligned with organizational policies and accreditation standards.
• Serves as an internal resource and subject-matter expert on credentialing policies, workflows, systems, and best practices; provides guidance to team members and cross-functional partners as needed.
• Manages the credentialing shared inbox, ensuring triage, prioritization, and resolution of incoming requests, inquiries, and escalations within established service-level expectations.
• Monitors, tracks, and reports on certification and credentialing escalations to ensure timely, accurate, and compliant resolution; initiates follow-up actions and coordinates cross-functional support as needed.
• Facilitates and coordinates meetings with internal departments and external stakeholders to address certification and credentialing issues, concerns, or process dependencies; documents outcomes and drives execution of agreed-upon action items.
• Supports the development, review, and ongoing maintenance of provider communication materials, including notices, guides, templates, and FAQs, to ensure accuracy, clarity, and alignment with current certification and credentialing requirements and organizational expectations.
• Assists in developing, compiling, and distributing routine and ad hoc reports on certification and credentialing metrics, KPIs, backlog trends, workflow timeliness, and quality indicators; contributes to presenting findings to leadership and recommending improvement strategies.
• Collaborates with internal teams to validate system updates, contributes to process documentation, and assists in readiness efforts for audits or accreditation reviews.
• Participates in or leads special projects, workflow assessments, and operational initiatives focused on enhancing credentialing efficiency, provider experience, and organizational compliance.
• Regular and reliable attendance at work.
• Performs other duties as assigned.

Competencies

• Communication / People Skills: Effectively influences and persuades others in both favorable and challenging situations to achieve desired outcomes. Adapts communication and interaction style to effectively connect with diverse individuals and audiences. Listens attentively and critically to ensure understanding and informed responses, as well as to facilitate clear communication and effective collaboration. Communicates clearly and concisely in both written and verbal formats.
• Computer Literacy: Proficient in navigating multiple systems, including Microsoft applications, department-specific tools, and organization-wide platforms, to perform tasks.
• Coping / Flexibility: Maintains resilience when adapting to diverse situations and stakeholders, sustaining focus and applying a professional, solution-oriented approach to problem solving.
• Empathy / Customer Service: Consistently demonstrates customer-focused behaviors that anticipate needs and support a positive service experience. Exhibits a helpful and service-oriented approach, characterized by active listening, patience, respect, and genuine empathy for others’ perspectives.
• Independent Thinking / Self-Initiative: Applies critical thinking to independently prioritize the issues and activities that most directly drive desired outcomes. Demonstrates a strong sense of ownership by advancing work independently, securing required resources, and driving tasks to completion without the need for direction.
• Information Management: Ability to analyze large volumes of data, derive sound conclusions, and concisely and clearly communicate insights to diverse stakeholders.
• Organizational Skills: Demonstrates exceptional attention to detail and the ability to effectively prioritize, coordinate, and manage multiple tasks or stakeholders. Adapts to shifting priorities and deadlines while efficiently utilizing available systems and resources to achieve timely, accurate outcomes.
• Problem Solving / Analysis: Ability to resolve issues by applying systematic process analysis and exercising sound, informed judgment. Maintains a realistic and accurate understanding of relevant issues when evaluating problems and determining solutions.
• Technical Skills: Practical understanding of URAC standards, VA CCN and TRICARE regulations and requirements, as well as medical terminology. Current and applied knowledge of primary source verifications for initial credentialing, re-credentialing, and provider certifications. Current and applied knowledge of delegated credentialing processes. Proficient with credentialing software and provider data management systems. Proficient with Microsoft applications (Outlook, Teams, Word, Excel, PowerPoint, and SharePoint) and other tools.

Working Conditions

• Availability to cover any work shift as needed
• Travel may be required
• May work within a standard office environment
• Extensive time utilizing a computer with prolonged sitting