Credentialing Specialist

About the role

The Credentialing Specialist plays a crucial role in ensuring providers are credentialed and enrolled quickly and accurately with health plans and hospitals. This ensures patients always have uninterrupted access to care.

Responsibilities

• Filling out provider enrollment applications with health plans, Medicare, Medicaid and hospitals.
• Following up with health plans and hospitals on submitted applications.
• Solving complicated credentialing-related issues directly with IPAs and health plans.
• Maintaining a clean database of provider data and enrollment-related activities in MD Staff.
• Applying for license renewals.
• Communicating with providers on credentialing-related updates.

Requirements

• Bachelor’s degree in healthcare administration, business, or related field (preferred).
• 3+ years of experience in provider credentialing.
• Strong knowledge of NCQA standards, payer requirements, and credentialing best practices.
• Excellent problem-solving and critical thinking skills, with the ability to resolve escalated issues.
• Exceptional organization skills, with sharp attention to detail and ability to manage multiple priorities.
• Strong written and verbal communication and interpersonal skills to collaborate cross-functionally and with external stakeholders.
• Experience with credentialing software and databases (preferred).

Qualifications

• None specified.

Skills

• Strong organizational and problem-solving skills.
• Excellent communication and interpersonal skills.
• Proficiency with credentialing software and databases.

Benefits

• Health benefits include medical, dental, and vision.
• Life insurance.
• Paid leaves.

Pay

• Hourly pay range: $24 - $33 USD.

Schedule

• This full-time role is in-person in Chino.