Credentialing Specialist

About QualDerm Partners

QualDerm Partners is the largest multi-state dermatology network founded and owned by females in the U.S., operating across 150+ locations in 17 states. Our mission is to educate, protect, and care for skin health through comprehensive and accessible dermatologic care, promoting awareness of skin cancer prevention and encouraging annual skin exams.

Role Purpose

Under the guidance of the Senior Director of Credentialing and Revenue Cycle, the Credentialing Specialist is responsible for managing the credentialing, re-credentialing, payer enrollment, and privileging processes for healthcare providers within a designated region. The specialist will foster collaborative relationships with operational leaders to ensure credentialing needs are proactively communicated and completed before services commence under approved health plans. This role involves standardizing credentialing processes and maintaining accurate provider data across QualDerm's systems to support various stakeholders.

Key Responsibilities

• Manage all provider credentialing and payer enrollment activities with third-party payers and healthcare partners within the assigned region.
• Ensure compliance with health plan certification and credentialing requirements.
• Regularly interface with regional operational leaders to support provider onboarding and credentialing requirements.
• Maintain up-to-date provider information in credentialing databases and online platforms.
• Oversee timely renewals of licenses, certifications, and credentialing credentials.
• Protect the confidentiality of provider-related data.
• Coordinate information flow between payers, contracted Physician Hospital Organizations (PHOs), Accountable Care Organizations (ACOs), and other QualDerm networks.
• Prepare and manage reporting for assigned regions.
• Lead continuous process and quality improvement initiatives related to payer enrollment, data entry, credentialing committees, and broader credentialing functions.
• Support training efforts for new team members in Credentialing and Enrollment functions.

Qualifications

• Bachelor's degree preferred in a relevant field.
• At least three years’ experience in managed care credentialing or hospital medical staff services.
• Experience with national or multi-state credentialing processes is advantageous.
• Strong analytical, problem-solving, and resolution skills.
• Capability to communicate effectively and discreetly with medical practitioners and providers.
• Thorough understanding of NCQA, Joint Commission, URAC, CMS standards, and applicable state laws related to provider credentialing.
• Ability to prioritize and meet ongoing deadlines to ensure timely credentialing completion.
• Autonomous working ability within a matrix organizational environment.

Benefits

• Competitive salary rewarding your contributions.
• Comprehensive health insurance covering medical, dental, and vision.
• Generous 401(k) retirement plan with immediate vesting and company match.
• Paid Time Off from the first day, including 6 holidays and 2 floating holidays annually.
• Company-paid basic life insurance with options for additional coverage.
• Short-term and long-term disability insurance for unforeseen events.
• Additional wellness plans such as accident, critical illness, and identity theft coverage.
• Employee Assistance Program offering confidential support services.
• Exclusive discounts on various products and services for employees.
• Referral bonus opportunities for recommending qualified candidates.

Additional Information

QualDerm Partners is an equal opportunity employer committed to fostering diversity and an inclusive work environment. All applicants must have current authorization to work in the United States on a full-time basis.

Compensation Range: $48,152 to $64,916 annually, with the offer based on expertise, experience, location, and internal equity.