3mo
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Credential Analyst-NCQA, URAC and CMS
Lombard or Southfield or Richardson
$38k-$80k/yr HybridFull Time
2+ YOEBachelor degree or 6 years accreditation experience; knowledge NCQA/URAC/CMS; strong data, analytical, MS Office.
Microsoft Office, Excel, Email, Internet
1w
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HEDIS Audit Quality Manager (State and NCQA)
Atlanta or Woodland Hills or Waukesha or Hanover or Indianapolis or Miami or Cincinnati or Grand Prairie or Chicago or Iselin or Lake Mary or Woburn or Mendota Heights
$99k-$163k/yr HybridFull Time
3+ YOEBA/BS in a health care field and minimum 3 years healthcare experience plus 3 years QA/QI experience or equivalent; strong knowledge of NCQA HEDIS audit guidelines, audit management, project planning, and data analysis.
1mo
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Credentialing Specialist
Austin, Texas, United States
HybridFull Time
1+ YOEGathers and documents physician data for credentialing; investigates discrepancies; maintains provider records; performs credentialing and re-credentialing per NCQA standards.
17h
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Data Analyst - Remote
Chicago or Atlanta or Minneapolis or Omaha or Dallas or Phoenix
$60k-$107k/yr RemoteFull Time
2+ YOE2+ years SQL and healthcare data experience, intermediate Microsoft Excel (PivotTables/dashboards), analytic and communication skills, HEDIS/NCQA knowledge preferred.
SQL, Microsoft Excel, PivotTables
5d
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Appeals & Grievances Quality Auditor
Arkansas or Arizona or Florida or Georgia or Iowa or Illinois or Kansas or Kentucky or Michigan or Minnesota or Missouri or North Dakota or Nebraska or Oklahoma or South Dakota or Tennessee or Texas or Virginia or Wisconsin
$57k-$85k/yr RemoteFull Time
5+ YOEBachelor's degree or equivalent experience and 5 years directly in health plan appeals & grievances; strong audit, analytical, regulatory (CMS/NCQA) and quality improvement skills.
3w
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HEDIS Coordinator
Corpus Christi, Texas, United States
OnsiteFull Time
Bachelor's in related field required; experience with HEDIS/ECDS, clinical data acquisition, validation, and stakeholder coordination; proficiency with Microsoft Office; knowledge of NCQA/HEDIS preferred.
Microsoft Word, Microsoft Excel, Microsoft Outlook, Microsoft PowerPoint
2mo
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Credentialing Specialist (22772)
Carrollton, Texas, United States
OnsiteFull Time
3+ YOE3+ years credentialing experience; Home Health/SNF credentialing; NCQA/CMS/Joint Commission knowledge; MS Office proficiency; HIPAA compliance; strong communication and organization.
Microsoft Office, Outlook, Excel, Word, Access
3w
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Credentialing Coordinator / Senior - Orthopedics
Bellaire, Texas, United States
OnsiteFull Time
3+ YOE3+ years credentialing or medical staff coordination experience; Associate's degree or equivalent; knowledge of NCQA/URAC/Joint Commission rules; intermediate Microsoft Word/Excel proficiency; CPCS preferred.
Microsoft Office, Microsoft Word, Microsoft Excel
2w
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Credentialing and Medical Staff Coordinator Sr
Dallas, Texas, United States
OnsiteFull Time
3+ YOEHigh school diploma, knowledge of anatomy/physiology and medical terminology, NCQA and JCAHO standards, 3+ years credentialing experience, CPCS or CPMSM certification upon hire or within two years.
1w
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Senior Regulatory Implementation and Assurance Analyst
Pennsylvania or Maryland or Washington or North Carolina or Louisiana or Kentucky or Kansas or Indiana or Illinois or Georgia or Iowa or Florida or Colorado or California or Delaware or Connecticut or Arkansas or Arizona or Alabama or Alaska or Nevada or Vermont or Tennessee or Idaho or Oklahoma or Hawaii or Mississippi or Utah or New Hampshire or New Mexico or Wyoming or North Dakota or South Dakota or Rhode Island or West Virginia or Missouri or Texas or District of Columbia or Ohio or New Jersey or Oregon or South Carolina or Virginia or Massachusetts or Nebraska or Minnesota or Michigan or Wisconsin or New York or Maine
$79k-$127k/yr HybridFull Time
5+ YOE5+ years interacting with regulators/auditors, bachelor’s degree or equivalent experience, knowledge of regulatory frameworks (HIPAA, NIST, PCI, CMS, NCQA), strong communication, analytics, and project leadership skills.
2w
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Manager, Credentialing & Provider Enrollment
Houston, Texas, United States
OnsiteFull Time
8+ YOE8+ years healthcare credentialing experience, high school diploma (associate/bachelor preferred or may substitute for years), credentialing certification preferred, supervisory experience preferred, knowledge of NCQA and TJC requirements.
1mo
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Nurse - Clinical Review
Houston, Texas, United States
$65k-$75k/yr RemoteFull Time
1+ YOEActive unrestricted RN or LPN/LVN license; 1+ year utilization review experience; proficient in Microsoft Word, Excel, and PowerPoint; knowledge of NCD/LCD, insurance terminology, and URAC/NCQA standards.
Microsoft Word, Microsoft Excel, Microsoft PowerPoint
1w
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Multi-Site Certified Senior Medical Assistant - Specialty Care Clinic Float (Cypress)
Cypress or Cypress
OnsiteFull Time
5+ YOECertified MA with 5+ years medical assistant experience in specialty or complex chronic disease management; BLS required; CLIA/HIPAA/NCQA knowledge; EMR proficiency and strong communication and clinical skills.
Electronic Medical Record (EMR), MyChart
1w
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Senior Enrollment Specialist - Credentialing
United States or Texas
$68k-$82k/yr RemoteFull Time
4+ YOE4+ years credentialing experience, knowledge of payer enrollment and NCQA/state/federal standards, strong communication, attention to detail, database and Microsoft Office proficiency, high school diploma/GED required.
Database, Microsoft Excel, Microsoft Word, Adobe
1d
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Sr. Credentialing Specialist
Farmers Branch or Dallas
$19-$35/hr HybridFull Time
3+ YOE3+ years credentialing experience preferred, familiarity with NCQA standards, NAMSS CPCS preferred/obtainable, high school diploma required, intermediate Google Suites skills, experience with MD Staff database.
Google Suites, MD Staff
1mo
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Mgr, Credentialing
Irving, Texas, United States
$93k-$117k/yr OnsiteFull Time
4+ YOELead credentialing team, ensure NCQA/CMS and state compliance, manage credentialing/recredentialing/delegated processes, develop reporting, and coordinate onboarding; requires 4+ years related experience and bachelor's or equivalent.
Epic
3w
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Provider Performance Specialist-Senior
Alabama or Alaska or Arizona or Arkansas or Connecticut or Florida or Georgia or Idaho or Indiana or Iowa or Kansas or Kentucky or Louisiana or Maryland or Michigan or Mississippi or Missouri or Montana or Nebraska or Nevada or New Hampshire or New Mexico or North Carolina or Oklahoma or Rhode Island or South Carolina or South Dakota or Tennessee or Texas or Utah or Virginia or West Virginia or Wisconsin
RemoteFull Time
4+ YOEBachelor\u0002s or equivalent, 4 years payer/ACO/value-based care experience, advanced Excel and Power BI/Tableau, knowledge of Medicare Advantage/Medicaid/NCQA, strong analytical and communication skills.
Microsoft Excel, Power BI, Tableau
2w
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Credentialing and Medical Staff Coordinator Sr
Dallas, Texas, United States
OnsiteFull Time
3+ YOEHigh school diploma or equivalent, 3+ years credentialing experience, knowledge of anatomy/physiology and medical terminology, NCQA and Joint Commission standards, CPCS or CPMSM certification upon hire or within 2 years.
1mo
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Credentialing Coordinator
Dallas, Texas, United States
OnsiteFull Time
1+ YOEHigh school diploma/GED required; 1+ years credentialing experience; familiarity with MD Staff, Microsoft Excel/Word/Outlook; knowledge of NCQA/URAC/CMS/TDI credentialing standards; CPCS preferred.
MD Staff, Microsoft Excel, Microsoft Word, Microsoft Outlook, Windows
2mo
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Senior Physician Practice Manager
Sugar Land, Texas, United States
OnsiteFull Time
5+ YOE3+ MgmtOversee day-to-day practice operations; 5 years healthcare experience with 3 years supervisory; Bachelor's preferred; knowledge of CLIA, HIPAA, NCQA, OSHA; strong communication; focus on patient, provider, and staff satisfaction.
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