Credentialing Specialist

We are seeking a Credentialing Specialist with 2 to 5 years of experience to support credentialing and recredentialing operations for a growing health plan. This role will focus on maintaining provider data accuracy, supporting compliance with NCQA standards, understanding state and federal network participation regulations, and ensuring timely, audit - ready credentialing processes. Candidates with experience in NCQA-accredited or certified environments are preferred.

salary: $24 - $27 per hour
shift: First
work hours: 8 AM - 5 PM
education: High School

Responsibilities

Responsibilities

• Manage credentialing and recredentialing 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 recredentialing timelines and ensure timely completion
• Assist with delegation support, monitoring, and compliance tracking
• Maintain accurate, complete, and audit-ready credentialing records

SkillsMedallion (2 years of experience is required)Attention to detail (2 years of experience is required)Resolve Data (2 years of experience is required)Audits (2 years of experience is required)Health plan credentialing (2 years of experience is required)High Volume (2 years of experience is required)NCQA-focused (2 years of experience is required)
QualificationsYears of experience: 3 yearsExperience 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 [email protected].

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.