Managed Care Credentialing Specialist (Healthcare)

TL;DR

Managed Care Credentialing Specialist (Healthcare): Managing the credentialing and re-credentialing process for healthcare agencies and facilities to ensure compliance with managed care plan requirements with an accent on application accuracy and regulatory adherence. Focus on maintaining comprehensive credentialing databases, coordinating with legal and licensing teams, and acting as a liaison between facilities and external payor partners.

Location: Remote, USA

Company

A holding company of independent operating subsidiaries providing healthcare services such as home health, hospice, and senior living communities across the US.

What you will do

• Act as the primary liaison between agencies, facilities, and managed care plan partners.
• Manage the full cycle of initial credentialing and re-credentialing for assigned geographic regions.
• Prepare and submit accurate credentialing applications to meet managed care organization deadlines.
• Collaborate with Legal, Licensing, Accounts Receivable, and Payor Administration to verify necessary information.
• Maintain a comprehensive database of Agency and Community credentialing documentation.
• Respond to inquiries and provide necessary information to managed care organizations regarding credentialing matters.

Requirements

• Must be based in the USA.
• 3+ years of experience in credentialing or healthcare administration.
• Proficiency in MS Office (Excel, Word, Outlook, PowerPoint, SharePoint, Smartsheet) and Adobe PDF.
• Strong understanding of credentialing concepts, practices, and procedures.
• Exceptional organizational skills and attention to detail.
• Ability to handle strict confidentiality and operate with high integrity.

Nice to have

• Experience with Home Health, Hospice, Personal Care, and Senior Living Community credentialing.
• Knowledge of Managed Care Health Plans in Tennessee, Georgia, and Alabama.

Culture & Benefits

• Comprehensive benefits package including medical, dental, and vision plans.
• Retirement savings via 401(k) plan with company match.
• Generous PTO and paid holidays.
• Commitment to professional growth through free e-courses and training seminars.
• Empowered, flat leadership model promoting accountability and ownership.