Credentialing Specialist (Enrollment)

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.