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Credentialing and Contracting Medical Provider Network (MPN) Specialist
Remote / Online - Candidates ideally in
Sumter, Sumter County, South Carolina, 29153, USA
Listed on 2026-07-31
Sumter, Sumter County, South Carolina, 29153, USA
Listing for:
Tristar Insurance
Full Time, Remote/Work from Home
position Listed on 2026-07-31
Job specializations:
-
Healthcare
Healthcare Administration, Healthcare Compliance -
Administrative/Clerical
Healthcare Administration
Job Description & How to Apply Below
Credentialing and Contracting Specialist
Job DetailsLocation:
Remote (prefer candidates in Texas).Job Type: Full Time, Entry Level.
Category:
Admin – Clerical.
The Credentialing and Contracting Specialist is responsible for preparing and maintaining contracts and the contracts database system. This role maintains active status for all providers by completing initial and subsequent credentialing packages in compliance with state regulations, guidelines and policies.
Responsibilities- Review and screen credentialing applications for completeness, accuracy, and compliance.
- Perform primary source verification and validate documents such as state licenses, DEA certificates and malpractice coverage.
- Maintain provider contract files and resolve discrepancies, time gaps and other issues that impact credentialing.
- Monitor file completeness and accuracy, ensuring compliance with accreditation requirements and internal policies.
- Enter, update and maintain data in the credentialing database, ensuring accuracy and proper field use.
- Coordinate electronic verification requests and track responses to meet established timelines.
- Participate in process improvement initiatives for the credentialing workflow.
- Communicate clearly with providers, liaisons and staff to address day‑to‑day credentialing and provider issues.
- Assist in locating physicians for network staffing when needed.
- Maintain professional growth through industry affiliations and continuous learning about healthcare regulations.
- Perform miscellaneous job‑related duties as assigned.
- Excellent written and oral communication skills.
- Strong customer service orientation and timely email response.
- Proficiency in medical provider credentialing and accreditation principles, policies and documentation.
- Independent judgment and ability to manage confidential information.
- Advanced knowledge of Microsoft Word and Excel.
- Experience with Outlook, Word, Excel and other databases.
- Ability to learn new applications for remote work efficiency.
- Organized, able to prioritize multiple tasks and manage time effectively.
- High school diploma or equivalent required; GED acceptable.
- Medical, Dental, Vision Insurance
- Life & Disability Insurance
- Paid time off and paid holidays
- 401(k) plan
- Referral bonus
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