Job Title: Senior Credentialing Representative
Duration: Onboarding – October 20, 2025
Rate: $24.00 – $27.00 per hour
Key Responsibilities
Manage Credentialing: Handle initial and re-credentialing submissions for commercial and government payers (e.g., CMS, Medi-Cal, Medicare), with timely, accurate follow-through.
Primary Source Verification: Independently verify provider board certifications, licensures, and DEA registrations.
License & Renewal Tracking: Monitor expirations and process renewals for all necessary credentials.
System Data Entry: Maintain provider data in systems like CAQH, NPPES, PECOS, Symplr Payer, Cactus, MD Staff.
Ensure Compliance: Follow regulatory standards including NCQA, URAC, AAAHC, Joint Commission, and CMS guidelines.
Stakeholder Coordination: Liaise with providers, payers, hospitals, and internal teams to troubleshoot, escalate, and resolve credentialing issues.
Software & Technical Skills
Proficient with Microsoft Office (Excel, Word, PowerPoint, Smartsheet) and credentialing platforms like Symplr Payer , Cactus , PECOS , MD Staff .
Regulatory Expertise
Must understand and adhere to California-specific regulations , including CMS , CAQH , and Medi-Cal requirements.
Schedule, Interview & Location
Work Hours: Monday–Friday, 8:00 AM to 4:30 PM , plus daily training until proficient.
Interview Format: Face-to-face.
Work Location: On-site at Las Vegas, NV or fully remote —candidate to confirm preference.
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