Senior Credentialing Representative

About Our Client:The organization operates globally within the healthcare sector, focusing on improving health outcomes by connecting individuals with care, pharmacy benefits, data, and resources. It addresses challenges in health equity and access by leveraging technology to support millions of people in living healthier lives. About the Opportunity:The SENIOR CREDENTIAL REPRESENTATIVE role involves enrolling behavioral health providers with appropriate payers, ensuring compliance with credentialing standards. This position contributes to the organization's mission by maintaining accurate provider data and supporting access to healthcare services through effective credentialing processes. Responsibilities:Process provider applications and re-applications, including communications, verifications, reviews, and database entryConduct quality audits and provide feedback to improve accuracy and performanceResolve complex issues independently and identify new solutionsApply expertise to moderately complex credentialing tasksAnalyze data from multiple sourcesPrioritize daily responsibilities effectivelyDevelop credentialing policies and oversee primary source verificationInvestigate non-standard requests and problemsSupport and advise team members on processes and best practicesEvaluate complex requests and resolve issues independentlyFacilitate onboarding, training, and coaching for team membersMaintain compliance with standards such as NCQA, CMS, and state requirementsPerform additional duties as assigned Requirements:High School Diploma or GEDMinimum of 3 years experience in healthcare customer service or administrationMinimum of 3 years healthcare provider credentialing experienceAdvanced proficiency in Microsoft Excel and WordAccess to a quiet, secure workspace at home capable of protecting PHILocation with approved high-speed internet connection Preferred Qualifications:Experience with compliance workflows and NCQA policiesExperience in researching and applying government regulatory information Soft Skills:Ability to work independently and as part of a team with sound judgmentStrong organizational and time management skillsAbility to multi-task and meet deadlines in a fast-paced environmentExcellent verbal and written communication skills Pay Range and Compensation Package:Hourly pay ranges from $20.00 to $36.00 based on full-time employment Benefits & Perks:Paid Time Off and paid holidaysMedical, dental, and vision insuranceLife and disability insurance401(k) Savings PlanEmployee Stock Purchase PlanEducation reimbursementEmployee discounts and assistance programs Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin. Note:RemoteHunter is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.