CREDENTIALING SPECIALIST

Apply Job Type Full-time Description MAKE A DIFFERENCE AT OCHIN OCHIN is a nonprofit leader in health care innovation and a trusted partner to a growing national provider network, delivering the clinical insights and tailored technologies needed to expand patient access, strengthen care teams, and improve the health of rural and medically underserved communities. We are hiring for a number of new positions to meet increasing demand. When you choose to join OCHIN, you have the opportunity to continuously grow your skills and do meaningful work to help fulfill our vision of good health and well-being for everyone. At OCHIN, we value the unique perspectives and experiences of every individual and work hard to maintain a culture rooted in our values. Founded in Oregon in 2000, OCHIN employs a growing virtual workforce of more than 1,200 skilled professionals, working remotely across 49 states. We offer a generous compensation package and are committed to supporting our employees’ entire well-being by fostering a healthy work-life balance and opportunity for professional advancement. We are curious, collaborative learners who strive to live our values every day. OCHIN is excited to support our continued national expansion and the increasing demand for our innovative tools and services by welcoming new talent to our growing team. Position Overview: The Credentialing Specialist performs all aspects of the credentialing, privileging, and payor enrollment processes for providers under the OCHIN Collaborative or contracted third parties. The Business Partner – Credentialing Specialist will manage credentialing applications, verify credentials, and maintain provider files internally and externally with payor plans. Essential Functions: Timely processing of initial credentialing and recredentialing applications in accordance with regulatory requirements (NCQA, HRSA/FTCA, Joint Commission, AAAHC, CMS, or other regulatory standards). Reviewing and analyzing credentialing applications and supporting documents for accuracy and completeness. Validating and verifying provider credentials (licensure, DEA, specialty board, certificates, professional liability, and other required documents) through the appropriate verification sources. Identifying discrepancies in information, conducting research and follow-up, and escalating unresolved issues. Completing payor provider enrollment process, performing revalidations, maintaining CAQH profiles, NPPES registrations, provider data with payers and managing plan enrollment status in credentialing system. Other duties as assigned. Requirements Minimum of three (3) years of progressive experience in Credentialing and/or Provider Enrollment, 5+ years preferred. In-depth knowledge of credentialing, privileging and provider enrollment standards (HRSA, FTCA, TJC, NCQA, etc.) preferred. Experience in MD-Staff preferred. Certified Provider Credentialing Specialist (CPCS) may be required or strongly preferred. (Must be NAMSS not AAPC) Proficiency in credentialing software and data management systems is preferred. Advanced Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, etc.) preferred. Working knowledge of Smartsheet including data structure, formula creation, basic workflows and automation preferred. Proven experience in client-facing roles, with the ability to build strong relationships and communicate effectively with diverse stakeholders preferred. Familiarity with Jira for issue tracking and task management preferred. Prior to moving forward to the team interview, all candidates are required to complete a 50–60-minute competency assessment. The assessment gives us insights into how your strengths, preferences, and work style align with th e OCHIN's nine core competencies. It’s not about passing or failing—it’s about understanding fit and setting you up for success. Physical Requirements/Work Environment: Constant interpersonal skills, teamwork, and customer service. Frequent creativity, mentoring, presentations, and teaching. Occasional decision making and independent judgment or action. Reading, speaking, writing, and understanding English. While performing the duties of the job, the employee is regularly required to sit for long periods of time; stand and walk; use hands to finger, handle or feel; reach with hands and arms. This position requires a virtual home-office environment, working remotely. The role routinely uses standard office equipment such as computers and mobile devices. Travel is required to support OCHIN’s business requirements for Go-Live installations or training which may require travel by air, vehicle, or train. Work Location and Travel Requirements OCHIN is a 100% remote organization with no physical corporate office location. Employees work remotely from home and many of our positions also support our member organizations on-site for new software installations. Nationwide travel is determined based on OCHIN business needs. Please inquire during the interview process about travel requirements for this position. Work from home requirements are: Ability to work independently and efficiently from a home office environment High Speed Internet Service It is a requirement that employees work in a distraction free workplace We offer a comprehensive range of benefits. See our website for details: https://ochin.org/careerCOVID-19 Vaccination Requirement To keep our colleagues, members, and communities safe, OCHIN requires all employees—including remote employees, contractors, interns, and new hires—to be vaccinated with a COVID-19 vaccine, as supported by state and federal public health officials, as a condition of employment. All new hires are required to provide proof of full vaccination or receive approval for a medical or religious exemption before their hire date. Equal Opportunity Statement OCHIN is an equal opportunity employer. We are committed to building a team that represents a variety of backgrounds, perspectives, and skills for the benefit of our staff, our mission, and the communities we serve. As an equal opportunity and affirmative action employer, OCHIN does not discriminate on the basis of race, color, ethnicity, national origin, sex (including pregnancy), gender identity, sexual orientation, genetic information (including family medical history), political affiliation, religion, marital or civil union status, parental status, age, disability status, military status, veteran status, or any other protected characteristics. All aspects of employment are based on merit, performance, and business needs. Base Pay Overview OCHIN uses broadened pay ranges to support equitable and market-aligned compensation practices. The final offer will be based on a variety of factors, including relevant skills, certifications, education, experience, training, responsibilities, internal equity, and market data. #LI-Remote Salary Description $23.56 - $37.69