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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