Credentialing Specialist
Remote | Contract
Overview
We are seeking a Credentialing Specialist with to 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
to 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
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