Credentialing Administrator

Description

We are seeking a detail-oriented and experienced Credentialing Administrator to join our dermatology practice. The Credentialing Administrator will be responsible for managing and maintaining the credentialing and re-credentialing process for all healthcare providers, ensuring compliance with regulatory and insurance requirements. The ideal candidate will have a strong understanding of credentialing procedures, excellent organizational skills, and the ability to communicate effectively with providers, payers, and internal staff.

• Oversee and manage the credentialing and re-credentialing processes for physicians, nurse practitioners, and other healthcare providers within the practice.
• Maintain up-to-date provider files, ensuring all documentation is current and compliant with federal, state, and payer-specific requirements.
• Prepare and submit applications for provider enrollment with commercial and government insurance plans (Medicare, Medicaid, private insurers, etc.).
• Track and monitor the status of credentialing applications, following up as needed to ensure timely approvals.
• Maintain credentialing databases and software, updating records as necessary.
• Coordinate with providers and practice administrators to ensure timely submission of required documentation.
• Monitor and ensure compliance with regulatory bodies, such as The Joint Commission (TJC), National Committee for Quality Assurance (NCQA), and the Centers for Medicare & Medicaid Services (CMS).
• Respond to inquiries regarding credentialing status and requirements.
• Assist in audits and provide reports on credentialing activities as needed.

• Associate’s or Bachelor’s degree in healthcare administration, business administration, or a related field (preferred).
• Minimum of 2-3 years of experience in medical credentialing, preferably in a Dermatology or multi-specialty practice.
• Knowledge of provider enrollment procedures with Medicare, and commercial payers.
• Familiarity with credentialing databases and software systems.
• Strong understanding of compliance regulations and industry standards.
• Excellent attention to detail and organizational skills.
• Strong communication and problem-solving abilities.
• Ability to work independently and manage multiple tasks efficiently.

• Competitive salary based on experience.
• Health, dental, and vision insurance.
• Paid time off and holidays.
• Professional development opportunities.
• Retirement plan options.

If you are a highly motivated professional with a passion for ensuring provider compliance and a commitment to excellence, we invite you to apply for this position. Please submit your resume along with a cover letter.