Job Description
Credentialing Specialist
Remote | Contract
Overview
We are seeking a Credentialing Specialist with 2 to 5 years of experience to support credentialing and recredentialing operations for a growing health plan. This role will focus on maintaining provider data accuracy, supporting compliance with NCQA standards, understanding state and federal network participation regulations, and ensuring timely, audit-ready credentialing processes. Candidates with experience in NCQA-accredited or certified environments are strongly preferred.
Responsibilities
Manage credentialing and recredentialing cases in Medallion
Review provider files for completeness and identify non-clean cases
Summarize gaps, risks, and missing elements for initial credentialing committee review
Conduct prov...