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

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  Manage credentialing and recredentialing cases in Medallion

  
  


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  Review provider files for completeness and identify non-clean cases

  
  


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  Summarize gaps, risks, and missing elements for initial credentialing committee review

  
  


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  Conduct prov...