job description
Are you a detail-oriented professional with a passion for ensuring compliance and accuracy in healthcare credentialing? Outsourced Quality Assured Services Inc. is seeking an experienced Credentialing Specialist to join our dynamic team in Bali. In this role, you will be responsible for managing the full lifecycle of provider credentialing, ensuring all documentation and processes meet regulatory standards and organizational policies.
As a Credentialing Specialist, you will play a critical role in maintaining the integrity of our provider network by verifying credentials, managing re-credentialing cycles, and collaborating with internal and external stakeholders. This is an excellent opportunity for someone who thrives in a structured yet fast-paced environment and is committed to delivering high-quality results.
If you are a self-starter with strong organizational skills and a keen eye for detail, we invite you to apply and become a key contributor to our mission of providing top-tier outsourced services.
Responsibility
- Manage the end-to-end credentialing process for healthcare providers, including initial applications, re-credentialing, and ongoing compliance monitoring.
- Verify and validate provider credentials, licenses, certifications, and work history in accordance with regulatory and organizational standards.
- Maintain accurate and up-to-date records in credentialing databases and ensure all documentation is properly filed and accessible.
- Collaborate with internal teams, including compliance, legal, and provider relations, to resolve credentialing issues and streamline processes.
- Communicate effectively with providers, insurance companies, and other stakeholders to gather necessary information and clarify requirements.
- Monitor and track credentialing deadlines, ensuring timely submission and renewal of provider credentials to avoid lapses.
- Stay current with industry regulations, accreditation standards, and best practices to ensure compliance and mitigate risks.
- Generate reports and analytics on credentialing status, trends, and potential areas for process improvement.
Qualifications
- Bachelor's degree in Healthcare Administration, Business, or a related field preferred.
- Minimum of 2 years of experience in provider credentialing, preferably in a healthcare or managed care setting.
- Strong knowledge of credentialing standards, including NCQA, URAC, and state-specific regulations.
- Proficiency in credentialing software and databases, with advanced skills in Microsoft Office Suite.
- Excellent attention to detail and ability to manage multiple tasks with tight deadlines.
- Strong written and verbal communication skills, with the ability to interact professionally with providers and stakeholders.
- Self-motivated and able to work independently in a remote or hybrid environment.
- Certification as a Certified Provider Credentialing Specialist (CPCS) is a plus.