REMOTE Credentialing Specialist for Legal Appeals & Committee Liaison

Excel. Empower. Advance. Shine. Belong. Explore. Flourish. Champion. Make It Happen At Hopkins! Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine, one of the premier health delivery, academic, and research institutions in the United States. JHHP is a $2.5B business serving over 400,000 lives with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHP has become a leader in provider-sponsored health plans and is poised for future growth. The Credentialing Legal Appeals Coordinator is a highly visible role that reports directly to the Credentialing Supervisor. The incumbent is responsible for processing high-risk credentialing files and ensuring accuracy, compliance, and timely completion of all related activities. Key responsibilities include coordinating meetings with the Chairman of the Special Credentials Review Committee (SCRC), board members, and legal counsel; creating, preparing, and presenting reports to the SCRC; and developing risk assessment packets for review. The role also involves preparing additional reports as needed, scheduling and attending legal meetings and appeal hearings, and creating meeting agendas and minutes. This position requires the ability to manage a demanding workload while meeting strict deadlines. The ideal candidate will possess exceptional written, verbal, and interpersonal communication skills, with the ability to effectively engage with internal and external stakeholders, including attorneys, medical directors, and healthcare providers. Strong analytical skills are essential to coordinate information from multiple sources, identify errors, and detect subtle inconsistencies in documentation. This role maintains high visibility across the Health System and plays a critical role in supporting credentialing quality and risk management processes.

Requirements

Experience: Requires thorough knowledge of provider credentialing principles, methods, and procedures, typically acquired through a minimum of three (3) years of credentialing experience. Demonstrated experience managing the process of challenging rejected healthcare provider applications in a managed care credentialing environment is required, such as a Credentials Verification Organization (CVO), Managed Care Organization (MCO), Health Maintenance Organization (HMO), or hospital-based credentialing setting (MSO). Education: Requires a professional level of knowledge in business administration and/or management, generally obtained through at least two years of college coursework or equivalent work-related experience. A Bachelor’s degree is preferred. Knowledge: Comprehensive understanding of credentialing policies and procedures, including accreditation standards and regulatory requirements related to managed care. Skills:

• Strong organizational skills with the ability to manage a demanding workload with minimal supervision.
• Ability to effectively communicate with internal and external stakeholders regarding the interpretation of policies and procedures and identify potential issues.
• Ability to interact professionally with internal and external parties, including legal counsel, regarding sensitive and confidential matters.
• Excellent written, verbal, and interpersonal communication skills.
• Strong technical proficiency with automated support systems and related technologies.
• Strong analytical ability to coordinate information from multiple sources, detect errors and subtle inconsistencies in documentation, and develop reports and supporting materials.

Licensure/Certification: CPMSM (Certified Professional Medical Services Management) or CPCS (Certified Provider Credentialing Specialist) certification preferred but not required. Salary Range: Minimum 24.32/hour - Maximum 40.16/hour. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility. In cases where the range is displayed as a $0 amount, salary discussions will occur during candidate screening calls, before any subsequent compensation discussion is held between the candidate and any hiring authority. The Hospital reserves the right to modify employee schedules as needed. We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices. Johns Hopkins Health System and its affiliates are drug-free workplace employers.