CAQH Specialist

Physicians Practice Enhancement LLC

Red Bank, NJRemote OKFull time
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Location
Red Bank, NJ
Work style
Remote OK
Job type
Full time
Posted
Oct 21
1 day ago
Career path

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About the company

Physicians Practice Enhancement LLC

Hospitals and Health Care · 201 to 500 employees

With over 20 years of experience, Physicians'​ Practice Enhancement, LLC builds collaborative partnerships with our clients that are powered by strategic synergy. PPE is committed to providing high-quality, cost-effective management services. Our flexible, performance-driven approach is the foundation to our long-established history of providing customized physician and program management services to hospitals, healthcare facilities and post-acute facilities.

Physicians Practice Enhancement LLC on LinkedIn

What you'll do

  • The CAQH Specialist is responsible for maintaining accurate provider profiles in the CAQH portal to ensure timely credentialing and payer enrollment.
  • They must proactively resolve data deficiencies, monitor attestation deadlines, and coordinate with internal teams and providers.

What you need

  • Candidates must have a high school diploma or equivalent, with an associate degree preferred.
  • The role requires strong data entry experience, attention to detail, and proficiency with spreadsheets and remote collaboration tools.
  • Education: a high school diploma or an associate degree

Key skills

CAQH Provider Data PortalCredentialingPayer EnrollmentData EntryAttention To DetailOrganizational SkillsWritten CommunicationSpreadsheetsDocument ManagementRemote CollaborationQuality AuditsProcess Improvement

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Read the full posting here
POSITION SUMMARY The CAQH Specialist maintains complete, accurate, and current provider profiles in the CAQH Provider Data Portal to support timely credentialing and payer enrollment. This role owns assigned provider records, proactively resolves deficiencies, coordinates with providers and internal teams, and meets defined quality and turnaround expectations. ESSENTIAL RESPONSIBILITIES * Create, update, and maintain CAQH profiles for assigned healthcare providers, including demographics, practice locations, education, training, licenses, certifications, insurance, and work history. * Monitor attestation and reattestation requirements; coordinate provider review and authorization and complete permitted actions within established deadlines. * Collect, verify, and upload required supporting documents; track expirations and resolve missing, inconsistent, or outdated information. * Identify discrepancies between CAQH, internal credentialing systems, and payer enrollment records; escalate material mismatches. * Communicate professionally with providers, practice contacts, and credentialing/enrollment colleagues to obtain outstanding items. * Document work performed, follow-up attempts, barriers, and completion dates in designated systems; maintain reliable status reporting. * Prioritize urgent provider starts, payer deadlines, expiring credentials, and overdue tasks according to department SLAs. * Protect confidential provider information and follow company security, privacy, access-control, and approved remote-work procedures. * Participate in quality audits, process improvement, and cross-training as assigned. QUALIFICATIONS * High school diploma or equivalent required; associate degree or relevant training preferred. * Data Entry Experience * Strong attention to detail, organizational skills, follow-through, and written communication. * Comfort with spreadsheets, shared work queues, secure document systems, and remote collaboration tools. * Ability to manage a high-volume assigned portfolio with minimal supervision. PERFORMANCE EXPECTATIONS Performance will be assessed through profile accuracy, timely attestations, document completeness, work-queue aging, productivity, provider responsiveness, and adherence to assigned SLAs. Specific numeric targets will be set by department leadership. WORKING CONDITIONS & EQUAL OPPORTUNITY Remote computer-based work with routine video/telephone collaboration. ProCred is committed to equal employment opportunity and considers qualified applicants without regard to legally protected characteristics. Reasonable accommodations are available in accordance with applicable law.

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