Credentialing and Enrollments Specialist

Credentialing and Payer Enrollments

• Prepare, submit, and manage provider credentialing and payer enrollment applications for commercial, Medicare, Medicaid, and other health plans.
• Cook up initial credentialing, recredentialing, and provider data maintenance processes for physicians and advanced practice providers.
• Maintain accurate and up-to-date provider files, including CAQH profiles, NPI information, state licenses, DEA certificates, malpractice insurance, board certifications, and other required documentation.
• Maintain all credentialing, enrollment, and contracting records within CredentialStream and other designated databases.
• Monitor credentialing and enrollment statuses through payer portals and follow up regularly to ensure timely approvals.
• Track expiration dates for licenses, certifications, malpractice coverage, and other required documents to ensure continuous compliance.
• Respond to payer requests for additional documentation or clarification in a timely manner.
• Communicate credentialing and enrollment status updates to leadership, billing managers, clinic managers, providers, and other stakeholders as needed.
• Aid in onboarding new providers, including coordinating credentialing timelines, payer enrollments, and hospital privileging requirements.
• Support provider offboarding activities, including payer terminations and record updates.

Qualifications & Requirements

• Education: High school diploma or equivalent required. Associate degree or higher preferred.
• Experience: Minimum of 2 years of experience in provider credentialing, payer enrollment, medical staff services, or healthcare administration required. Experience with commercial and government payer enrollment processes strongly preferred.
• Skills & Abilities: Strong attention to detail and organizational skills; excellent written and verbal communication skills; ability to prioritize tasks and manage multiple deadlines effectively; ability to work independently and collaboratively in a remote environment; proficiency in Microsoft Office Suite, EHR systems, practice management software, and online credentialing portals; strong problem-solving and follow-up skills.

Compensation

The hourly range will be discussed during the interview process. Actual compensation will be determined based on a variety of factors, including the candidate’s experience, education, skills, and qualifications.

Physical Requirements

Ability to stand, walk, and move throughout the clinic, if applicable, for extended periods; occasionally lift objects up to 25 lbs., bend, stoop, or reach as needed. Frequent use of hands and fingers for patient care and equipment operation. Must have normal (or corrected) vision and hearing and be able to respond quickly in a fast-paced clinical environment, if applicable.

What We Offer

• Competitive salary and benefits package, including medical, dental & vision insurance, 401(k) retirement plan with employer matching, and professional development opportunities
• Paid time Off (PTO), sick time, floating holiday and holiday pay
• Opportunity to shape the future of a thriving allergy and asthma practice in beautiful San Diego (and across our expanding network)
• A supportive, mission-focused culture where your contributions directly impact patient outcomes and team growth

California Consumer Privacy Act (CCPA) Notice

Modena Health (“MH”) and Modena Allergy & Asthma ("MAA") complies with the California Consumer Privacy Act (“CCPA”). Personal information provided in the job application process will be collected, used, and retained in accordance with applicable privacy laws. Candidates may request additional information regarding the categories of personal information collected and the purposes for which it is used during the hiring process.

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