Job description
#1 PH Workforce Delivering to the US.
MedCore Solutions is expanding and we are looking for an experienced and detail-oriented Credentialing Specialist to manage the end-to-end credentialing process for healthcare providers across various payers and networks. The ideal candidate will have in-depth knowledge of U.S. healthcare credentialing requirements and processes, with specific experience in Medicare CPT credentialing. This role ensures that all providers are properly enrolled and maintain active status with insurance networks, including Medicare, Medicaid, and commercial payers.
Who We Are MedCore Solutions (MCS) is the leading provider of healthcare administration services, specializing in areas such as medical billing, credentialing, insurance verification, and virtual staffing. We aim to connect top talent with robust and fulfilling career opportunities in the ever-evolving healthcare landscape.
Responsibilities
Manage initial credentialing, re-credentialing, and enrollment processes for physicians and allied health professionals.
Complete and submit applications for provider enrollment with Medicare, Medicaid, and commercial payers.
Perform primary source verifications, background checks, and licensure validations in compliance with NCQA, CMS, and payer-specific standards.
Maintain accurate and up-to-date records in credentialing databases and tracking systems.
Monitor expirables and coordinate timely renewals of licenses, certifications, and insurance.
Serve as a liaison between providers, billing teams, and payers to ensure credentialing-related issues are resolved promptly.
Ensure all credentialing files meet internal standards and external regulatory requirements.
Stay current with federal and state regulations related to provider credentialing.
Minimum of 3 years of credentialing experience within a U.S. healthcare setting.
In-depth knowledge of credentialing processes and compliance regulations
Familiarity with optometric practices and the associated documentation requirements
A background in insurance claim filing and processing would be a plus.
Amenable to work in a graveyard shift (US time hours)
Demonstrated experience with Medicare CPT credentialing and payer enrollment.
Experience credentialing both Nurse Practitioners (NPs) and Doctors (MDs/DOs) for commercial and government insurance plans.
Familiarity with CAQH, PECOS, and NPPES systems.
Strong understanding of provider types, billing practices, and credentialing standards.
Exceptional organizational skills with the ability to manage multiple priorities and meet deadlines.
Proficient in Microsoft Office Suite and credentialing software (e.g., Verity, IntelliSoft, MD-Staff).
Other details:
Start Date: ASAP
Schedule: TBD
Days Off: Saturday & Sunday
Time zone: Pacific Standard Time/Eastern Standard Time
Our Commitment to delivering high-quality results for our clients and the only way to do that is ensuring a rewarding, respectful and productive experience for our employees. We hold the same values for both our customers and our employees.
- Permanent Work From home
- Permanent Weekends Off
- Great Company Culture and No Micromanagement
