Are you a healthcare administrative pro with specialized experience in provider credentialing? Spherion Staffing is actively seeking an experienced Healthcare Credentialing Specialist to manage provider onboarding and health plan network enrollment. In this critical role, you will verify provider qualifications, process primary source verifications, and ensure full compliance with major managed care health plan standards. If you are detail-driven, thoroughly understand managed care enrollment, and live right here in Brownsville or the Rio Grande Valley, we want to talk to you!
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Responsibilities:
Provider Onboarding: Process primary source verification, credentialing, and re-credentialing applications for healthcare providers in accordance with health plan and regulatory standards.
Compliance & Auditing: Maintain accurate provider files, audit documentation for completeness, and ensure compliance with NCQA, state, and managed care requirements.
Network Enrollment: Submit, track, and follow up on provider enrollment applications with major health plans to ensure timely roster updates and billing enablement.
Database Management: Keep internal database records updated with primary source verifications, licenses, DEA certificates, malpractice insurance, and board certifications.
Communication & Coordination: Serve as the main point of contact for providers and internal teams regarding application status, missing documentation, or credentialing delays.
Working hours: 8:00 AM - 5:00 PM
Skills:
Proficiency in both English and Spanish is a plus.
Multi-Payer Experience: Familiarity with Texas Medicaid/Medicare health plan enrollment portals and delegated credentialing processes.
Education:
High School
Experience:
1-4 years
Qualifications:
Credentialing Expertise: 1???2+ years of hands-on experience in healthcare credentialing, provider data management, or medical billing/claims.
Verification & Portals: Demonstrated experience performing PSV (via NPDB, OIG, state boards) and navigating the CAQH portal.
Regulatory Standards: Solid understanding of NCQA or CMS credentialing guidelines.
Technical Skills: Advanced proficiency in Microsoft Excel for data tracking, along with fast, highly accurate data entry skills.
Local Residency: Must currently reside in the Brownsville (Cameron County) or wider RGV area.
If you have the experience and are interested Apply today and call 956-688-9333
Must reside within the Bronwsville and McAllen area.
Spherion has helped thousands of people just like you find work happiness! Our experienced staff will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temp-to-perm or direct hire opportunities, no one works harder for you than Spherion.
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 Spherion, 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 Callcenter@spherion.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, Spherion 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).