Medical Credentialing Specialist

Join Claim.

MD:
Simplifying Healthcare Through Innovation and Compassion Claim.

MD is a leading national electronic healthcare clearinghouse, supporting thousands of providers, payers, and software vendors across the country. Our mission is to simplify and optimize the flow of medical claims and related data, enabling healthcare organizations to operate more efficiently and deliver better patient outcomes. We are dedicated to streamlining healthcare transactions and improving operational efficiency for our users. Driven by a strong commitment to innovation and excellence, we seek individuals who are passionate about making a tangible difference in the healthcare industry.

• Collaborative Culture
  - Work alongside a team that values open communication, mutual respect, and shared success.
• Growth Opportunities
  - We invest in your professional development, offering training and pathways to advance your career.
• Flexible Work Environment
  - Enjoy the benefits of a work-from-home environment that supports work-life balance.
• Meaningful Impact
  - Contribute to a product that directly improves the efficiency of healthcare providers nationwide.

• Compensation Range - $76,000- $86,000 annually, based on experience and geographic location. Final compensation will be determined in accordance with state-specific pay transparency requirements.
• 4-Day (32-hour) Workweek
  - Full-time, exempt role with a 32-hour weekly schedule.
• Comprehensive Benefits Package
  - Including health, dental, and vision coverage, as well as retirement savings plan.
• Internet Reimbursement
  - Up to $100 per month for high-speed internet required for the role.
• Career Growth and Development
  - Opportunities for skill-building, advancement, and continuous learning.
• Work-Life Balance
  - Flexible schedules and a supportive, collaborative work environment
• Inclusive Company Culture - A commitment to diversity, equity, and inclusion in all our practices.
• Employee Wellness
  - Programs and resources focused on your overall well-being, including mental and physical health support.
• Work Remotely
  - Opportunity to work remotely.
• Paid-Time Off
  - Ten days of paid time off, in addition to a generous holiday schedule, to support your work-life balance and personal well-being.

The Medical Credentialing Specialist is responsible for researching, documenting, and maintaining the operational and regulatory requirements governing provider credentialing and enrollment across commercial, government, and managed care payers. This role manages credentialing resources and operational documentation that support consistent, accurate, and compliant provider enrollment activities.

Operating at the intersection of credentialing operations, payer requirements, regulatory compliance, and process management, the Medical Credentialing Specialist serves as a subject matter expert on provider credentialing standards and operational practices. This role evaluates credentialing requirements, monitors regulatory and payer changes, maintains operational documentation, and partners with internal stakeholders to support consistent, efficient, and compliant credentialing operations.

The following duties are considered essential to the successful performance of this position. These responsibilities are central to supporting operational excellence, maintaining compliance, and developing scalable credentialing resources that support Claim.

MD's healthcare operations.

• Credentialing Research & Knowledge Management
  • Research, interpret, and maintain provider credentialing and enrollment requirements for commercial, Medicare, Medicaid, and other payer organizations.
  • Analyze payer credentialing policies, provider manuals, enrollment guides, and regulatory resources to identify operational requirements, workflow considerations, and business impacts.
  • Manage credentialing documentation, operational references, and internal knowledge resources that support consistent business practices.
  • Organize credentialing resources, including payer requirements, documentation standards, operational guidance, timelines, and reference materials.
  • Periodically review credentialing resources to ensure information remains current, accurate, and aligned with evolving payer requirements and regulatory guidance.
• Payer Requirements and Operational Documentation
  • Maintain documentation addressing payer-specific credentialing requirements, enrollment prerequisites, revalidation schedules, and submission processes.
  • Evaluate payer-specific credentialing requirements to identify operational differences, documentation needs, and workflow impacts.
  • Standardize and enhance operational reference materials outlining payer workflows, documentation requirements, processing expectations, and operational considerations.
  • Ensure credentialing documentation remains accurate, organized, and audit-ready.
• Regulatory Monitoring and Compliance
  • Monitor federal, state, and payer-specific regulatory changes…