Credentialing Specialist / Administrator

Job Title: Credentialing Specialist / Administrator

Location: South Africa

Job Type: Full-Time, Remote

Hours: US Hours (9am-5pm EST)

Responsibilities

• Manage the credentialing and recredentialing process for healthcare providers to ensure compliance with regulatory standards.
• Collect, verify, and maintain accurate documentation of licenses, certifications, and educational qualifications for clinical staff.
• Submit and track credentialing applications with various insurance payers and collaborate with internal teams to facilitate the onboarding process.
• Monitor and maintain records of credentialing status, including expiration dates and renewal timelines.
• Assist in adherence to all state and federal regulations, ensuring that all providers meet qualifications for practice.
• Maintain comprehensive credentialing files and provide support during audits and evaluations.
• Collaborate with HR and leadership to ensure timely updates on new hires and terminations.
• Communicate effectively with payers, compliance teams, and providers to resolve any issues related to credentialing.

Requirements:
• Associate's degree in healthcare administration or a related field; Bachelor's degree preferred.
• Prior experience in credentialing, preferably in a healthcare, behavioral health, or ABA setting.
• Strong knowledge of medical licensing, insurance enrollment processes, and provider credentialing standards.
• Excellent organizational skills with keen attention to detail and ability to manage multiple projects.
• Strong verbal and written communication skills for effective stakeholder interaction.
• Proficient in Microsoft Office / Google Workspace and comfortable using credentialing software.
• Ability to work independently and maintain productivity in a remote work environment.

Benefits:
• Comfortable working U.S. hours
• Remote work from home

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