Credentialing Specialist 1

Credentialing Specialist 1

BCforward is currently seeking a highly motivated Credentialing Specialist 1 for an opportunity in Remote in FL!

Position Title: [Credentialing Specialist 1]

Location: [Remote - FL]

Anticipated Start Date: [ASAP]

Please note this is the target date and is subject to change. BCforward will send official notice ahead of a confirmed start date.

Expected Duration: [06 Months]

Job Type: [FULL TIME (>%3D30 HRS WEEKLY) [TEMP TO HIRE], [REMOTE]

Pay Range: [25.00] - [28.00]

Please note that actual compensation may vary within this range due to factors such as location, experience, and job responsibilities, and does not encompass additional non-standard compensation (e.g., benefits, paid time off, per diem, etc.).

Requirements:

• [1+ year of experience in data entry, customer service, medical office administration, provider data management, or healthcare operations (claims, billing, credentialing, etc.)
• NAMSS Credentialing Certification
• Familiarity with NCQA standards

Job Description:

Position Summary:

The Credentialing Specialist I is responsible for performing credentialing and re-credentialing activities for individual, facility, and/or ancillary providers across the state of Florida. This includes verifying provider data, collecting documentation, and ensuring compliance with NCQA and internal standards. The role supports timely provider onboarding to maintain quality healthcare access for members.

Key Responsibilities:

• Perform provider credentialing/re-credentialing tasks in compliance with NCQA standards.
• Verify and maintain provider information for network, individual, facility, and ancillary providers.
• Communicate professionally with physicians, office managers, certification agencies, training programs, and other stakeholders to obtain or clarify credentialing documents.
• Monitor disciplinary actions and ensure proper documentation is filed.
• Maintain accuracy of credentialing databases and systems.
• Track and file credentialing applications and process practitioner add requests from web submissions.
• Organize and submit cases for Credentialing Committee review, and assist with preparation of binders and post-meeting documentation.
• Manage internal SharePoint and S Drive practitioner folders.
• Collaborate with team via shared email inbox and internal communication platforms.
• Support internal audit readiness by maintaining quality and timely submission standards.
• Meet productivity metrics (75 completed requests/week) and maintain quality standards (goal: 99% audit score).

Education & Experience:

Required:

• High school diploma or equivalent
• 1+ year of experience in data entry, customer service, medical office administration, provider data management, or healthcare operations (claims, billing, credentialing, etc.)

Preferred:

• Associate's degree in Business Administration, Health Care Administration, or a related field
• NAMSS Credentialing Certification
• Familiarity with NCQA standards

Top Skills Required:

Ability to work under pressure - managing multiple credentialing requests while maintaining accuracy.

Strong time management - prioritizing and processing tasks efficiently to meet strict deadlines.

Excellent communication skills - email correspondence with providers and internal teams.

Benefits:

BCforward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.

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About BCforward:

Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward's 6,000 consultants support more than 225 clients globally.

BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.

BCforward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.

To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BCforward will only use this information to complete the recruitment process.

This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.

Interested candidates please send resume in Word format to Please reference job code 239071 when responding to this ad.

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