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 provider outreach to obtain missing or insufficient information Support roster submissions and validate data accuracy Assist with credentialing mailbox Assist with credentialing case coordination Prepare documentation for credentialing committee review Support internal and external audits, including NCQA and delegated entities Track recredentialing timelines and ensure timely completion Assist with delegation support, monitoring, and compliance tracking Maintain accurate, complete, and audit-ready credentialing records Qualifications 2 to 5 years of credentialing experience in a healthcare or health plan environment Experience in NCQA-accredited or certified credentialing programs strongly preferred Working knowledge of NCQA credentialing standards, delegation, and state and federal regulations Experience with Medallion preferred Strong attention to detail and ability to identify and resolve data issues Ability to summarize complex cases and communicate clearly Strong organizational and time management skills Preferred Background Health plan credentialing experience preferred NCQA-focused experience preferred over URAC or hospital or JCAHO-based experience Experience supporting audits, delegation oversight, and high-volume credentialing operations #J-18808-Ljbffr
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