Job Title: Credentialing Specialist / Medical Auditor (RN preferred)
Location: Las Vegas, NV - or fully remote
Schedule: Monday-Friday, 8:00 AM - 4:30 PM (training hours may vary until proficiency is reached)
Responsibilities:
Location: Las Vegas, NV - or fully remote
Schedule: Monday-Friday, 8:00 AM - 4:30 PM (training hours may vary until proficiency is reached)
Responsibilities:
- Credentialingapplications: Submission of initial and re-credentialing applications to contracted payers.
- Licensure maintenance: Track renewals and ensure compliance with state and board requirements.
- CAQH updates and NPPES enrollment.
- Roster delegation review: Perform quality checks and maintain accurate records.
- Data entry: Input and manage information in Symplr Payer.
- Primary source verification: Validate credentials with boards and licensure authorities.
- Compliance: Follow NCQA, CMS, AAAHC, URAC, and JC guidelines.
- Enrollment: Handle commercial and government payer enrollments.
- Hospital privileges: Manage and understand hospital privilege requirements.
- Symplr Payer, Cactus, Pecos, MD Staff
- Familiarity with California rules and regulations
- Knowledge of CMS guidelines, CAQH, and Medi-Cal
Job Title: Credentialing Specialist / Medical Auditor (RN preferred)
Location: Las Vegas, NV - or fully remote
Schedule: Monday-Friday, 8:00 AM - 4:30 PM (training hours may vary until proficiency is reached)
Responsibilities:
Location: Las Vegas, NV - or fully remote
Schedule: Monday-Friday, 8:00 AM - 4:30 PM (training hours may vary until proficiency is reached)
Responsibilities:
- Credentialingapplications: Submission of initial and re-credentialing applications to contracted payers.
- Licensure maintenance: Track renewals and ensure compliance with state and board requirements.
- CAQH updates and NPPES enrollment.
- Roster delegation review: Perform quality checks and maintain accurate records.
- Data entry: Input and manage information in Symplr Payer.
- Primary source verification: Validate credentials with boards and licensure authorities.
- Compliance: Follow NCQA, CMS, AAAHC, URAC, and JC guidelines.
- Enrollment: Handle commercial and government payer enrollments.
- Hospital privileges: Manage and understand hospital privilege requirements.
- Symplr Payer, Cactus, Pecos, MD Staff
- Familiarity with California rules and regulations
- Knowledge of CMS guidelines, CAQH, and Medi-Cal
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