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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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.
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