Credentialing SOP Specialist

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Job Overview BilliMD is seeking an experienced Credentialing SOP Specialist to design and document a comprehensive Standard Operating Procedure (SOP) for our medical provider credentialing process. This role is a project-based opportunity for a credentialing expert who understands the entire U.S. credentialing lifecycle—from initial application to payer enrollment, recredentialing, Medicare/Medicaid registration, and CAQH maintenance. You will analyze current practices, identify best practices, eliminate inefficiencies, and build a clear, structured SOP that our team can implement for long-term operational success. Responsibilities Evaluate Existing Processes: Analyze BilliMD’s current credentialing workflows and document detailed process steps. Create Step-by-Step Documentation: Develop clear, user-friendly SOPs covering all credentialing activities including: Provider intake and document collection Primary source verification Medicare (PECOS) and Medicaid enrollment Commercial insurance credentialing CAQH management and attestations Ongoing recredentialing and revalidation procedures Compliance Integration: Ensure all SOPs align with CMS, NCQA, URAC, HIPAA, and payer-specific requirements. Design Templates and Checklists: Create tools (e.g., checklists, approval forms, tracking sheets) to support consistent execution. Recommend Improvements: Identify workflow gaps or inefficiencies and propose practical enhancements to the credentialing process. Team Collaboration: Work closely with BilliMD’s Credentialing Director, compliance team, and leadership during the SOP development process.

Keyword: Design Expert

Administrative Support Communications Medical Billing & Coding Human Resource Information System Procedure Development Employee Communications