Job Description
We are seeking a detail-oriented Credentialing Specialist with 2 to 5 years of experience in a healthcare or health plan setting. In this role, you will manage end-to-end credentialing operations, oversee provider data within Medallion, prepare detailed summaries for our Credentialing Committee, and ensure rigorous adherence to NCQA standards. Key Responsibilities
- Lifecycle Case Management: Manage full-lifecycle initial credentialing and re-credentialing processes efficiently using the Medallion platform.
- File Review & Risk Assessment: Evaluate practitioner and organizational provider files for completeness, identifying non-clean cases and flagging compliance risks or documentation gaps.
- Committee Support: Prepare comprehensive documentation, case reports, and executive summaries for Credentialing Committee review.
- Provider Engagement: Conduct proactive, professional outreach to providers and clinical staff to retrieve missing documentation in a timely manner.
- Compliance & Audit Readiness: Track re-credentialing timelines, maintain audit readiness for NCQA and delegated entity evaluations, and perform regular roster verifications.
- Qualifications & Preferred Background
- Relevant Experience: 2 to 5 years of credentialing experience within a healthcare facility, managed care organization, or health plan.
- NCQA Standards: Proven background working within NCQA-accredited environments required.
- Technical Skills: Hands-on proficiency with Medallion or similar credentialing software systems.
- Core Competencies: Exceptional attention to detail, effective verbal and written communication skills, organized workflow management, and solid knowledge of delegation rules and regulatory requirements.
Why Join Us?
- Competitive compensation ($20–$26/hr) with direct path to permanent employment after 90 days.
- Be a part of a fast-growing health plan making high-quality healthcare accessible.
- Collaborate with a dedicated team committed to quality and operational excellence.
Ready to advance your credentialing career? Apply now!
salary: $20 - $26 per hour
shift: First
work hours: 8 AM - 5 PM
education: High School
Responsibilities
- Manage credentialing and re-credentialing cases in Medallion credentialing platform
- Review provider files for completeness and identify non-clean cases
- Summarize gaps, risks, and missing elements for initial credentialing committee review
- Conduct provider outreach to obtain missing or insufficient information
- Support roster submissions and validate data accuracy
- Assist with credentialing mailbox
- Assist with credentialing case coordination
- Prepare documentation for credentialing committee review
- Support internal and external audits, including NCQA and delegated entities
- Track re-credentialing timelines and ensure timely completion
- Assist with delegation support, monitoring, and compliance tracking
- Maintain accurate, complete, and audit-ready credentialing records
Skills
- Credentialing (2 years of experience is required)
- Confidentiality
- Verbal Communication
- Analytical Thinking
- Medical Software
- Filing
- Written Communication
- Basic Software Skills
- NCQA Standards (3 years of experience is required)
- Medallion credentialing system (2 years of experience is required)
Qualifications
- Years of experience: 3 years
- Experience level: Experienced
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Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.
At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com.
Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).
This posting is open for thirty (30) days.
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
Job Tags
Hourly pay, Permanent employment, Temporary work, Work experience placement, Shift work