Job description
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CPT-9958 Credentialing Specialist – California & Nevada
Independent Contractor – [Business Support VA/Junior -Senior Level] (Remote).
Overview
20four7VA is seeking offshore independent contractors to deliver remote services to clients worldwide, with a primary focus on developed markets such as the United States, the United Kingdom, Canada, and Australia.
The Credentialing Specialist is responsible for managing and maintaining the credentialing and re-credentialing process for healthcare providers in accordance with state, federal, and payer-specific requirements. This role focuses primarily on ensuring compliance for providers practicing in California and Nevada, coordinating with insurance payers, facilities, and regulatory agencies to ensure providers are properly enrolled, credentialed, and eligible for reimbursement.
The objective of each engagement is to assist the client in improving business efficiency, enhancing service delivery, or supporting operational functions through high-quality, task-specific services rendered by a qualified contractor.
Scope of Services
Contractors will be required to provide services that align with the following client tasks:
- Provider Enrollment & Credentialing
- Complete and submit initial credentialing, re-credentialing, and enrollment applications for Medicare, Medicaid, and commercial payers in California and Nevada.
- Verify provider credentials including education, training, licensure, board certifications, work history, malpractice coverage, and sanctions.
- Maintain and update provider information in credentialing databases and systems (e.g., CAQH, PECOS, NPPES).
- Track provider application status, ensuring timely follow-up and resolution of any delays or missing documentation.
- Manage provider terminations, demographic updates, and revalidations as required by payers.
- Compliance & Regulatory Requirements
- Ensure compliance with federal, state (CA and NV), and payer-specific credentialing standards.
- Monitor expirables (licenses, DEA, malpractice, etc.) and send timely renewal reminders.
- Maintain accurate and organized credentialing records in accordance with HIPAA and company policy.
- Stay updated on changes in credentialing regulations and payer requirements specific to California and Nevada.
- Communication & Coordination
- Liaise with providers, practice managers, payers, and internal departments to gather necessary documentation and resolve credentialing issues.
- Provide updates on provider status and credentialing progress to management and billing teams.
- Support audits and internal reviews related to credentialing and compliance.
Each engagement is based on a defined scope of work and is governed by an independent contractor agreement. Services must be performed professionally, with adherence to any timelines, guidelines, and deliverables agreed upon in writing.
Skills
The Contractor must demonstrate proficiency in the following, depending on the Client’s requirements:
- Strong organizational skills and attention to detail.
- Excellent communication and follow-up abilities.
- Proficient in Microsoft Office and credentialing software.
- Ability to manage multiple applications and deadlines simultaneously.
- Analytical thinking and problem-solving skills.
Experience:
- Minimum of 2 years of credentialing or provider enrollment experience in a healthcare setting.
- Strong familiarity with California and Nevada payer requirements, including Medi-Cal, Nevada Medicaid, and major commercial plans.
- Experience with Medicare (PECOS), NPPES, and CAQH systems required.
- Knowledge of NCQA, CMS, and Joint Commission credentialing standards preferred.
Preferred Certifications
- Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) – a plus but not required.
Work Schedule
- Contracted Hours per Week: 40 hours/week
- Scheduled Working Days: Monday through Friday
- Daily Working Time: 8AM - 5PM PST
Note: The Company will make reasonable efforts to align the Assigned VA’s schedule with the Client’s preferred hours as set forth above. However, availability may vary based on time zones, capacity, and the contracted hours set in this SOW. Any changes must be mutually agreed to in writing through a revised SOW.
Terms of Engagement
- Contractors will operate under a Master Services Agreement and a Statement of Work
- This is not an offer of employment; contractors are not employees of 20four7VA or any client
- All compensation is processed through 20four7VA according to the terms of the engagement
By submitting your application, you acknowledge that this opportunity is for an independent contractor engagement and not an offer of employment. All applications will be reviewed based on alignment with client needs, qualifications, and availability. If selected, a member of our team will reach out to discuss next steps and potential client matching.
We look forward to reviewing your application and potentially working with you on future client engagements!
