Credentialing Specialist

Native preference in hiring is given to qualified enrolled members of Paskenta Band of Nomlaki Indians and Native Americans in accordance with the Band’s Preference Policy. Applicants claiming Indian preference must submit verification of Indian heritage certified by tribe of affiliation or other acceptable documentation.

About the Role

The Credentialing Coordinator serves as Rolling Hills Clinic's internal owner and central point of coordination for provider credentialing, privileging, recredentialing, payer enrollment, onboarding readiness, provider records, professional-license oversight, CAQH and payer-portal administration, and related organizational communication. The position works closely with contracted credentialing and payer enrollment vendors and ensures each provider file is initiated, supported, tracked, completed, communicated, and maintained. This role manages Rolling Hills Clinic's internal workflow, documents, approvals, deadlines, portals, records, communication, and accountability.

Responsibilities

• Provider Onboarding and Readiness Coordination
  • Receive notification of new employees, locum tenens providers, contractors, and other practitioners requiring credentialing or payer enrollment.
  • Initiate credentialing, privileging, and payer enrollment requests with the appropriate contracted vendors.
  • Distribute provider applications, instructions, and document requests; monitor completion and follow up on missing or incomplete information.
  • Track anticipated start dates, onboarding dependencies, clinical approval, payer readiness, and outstanding requirements.
  • Maintain a consolidated provider-readiness tracker across medical, dental, specialty, behavioral health, and physical therapy service lines.
  • Coordinate provider status and readiness information with Human Resources, site managers, Operations, clinical leadership, Revenue Cycle, and other authorized stakeholders.
• Credentialing, Privileging, and Recredentialing Coordination
  • Serve as the primary organizational liaison for the credentialing, privileging, recredentialing, and reprivileging contractor.
  • Submit complete provider intake information and organizational documents to the contractor and respond promptly to follow-up requests.
  • Coordinate Medical and Dental Director review, recommendations, peer review or competency documentation, and governing-body approval workflows in accordance with organizational policy.
  • Track initial credentialing, temporary privilege, privilege, recredentialing, and reappointment deadlines.
  • Confirm completed files are returned, retained, and available for internal review, audit, accreditation, or regulatory purposes.
  • Escalate missing documents, delays, discrepancies, or expiring approvals that may affect provider start dates or continued practice.
• Payer Enrollment Coordination
  • Serve as the primary organizational liaison for the payer enrollment contractor.
  • Initiate provider additions, reassignments, enrollments, demographic changes, location changes, and terminations with applicable payers.
  • Provide requested organizational records, signatures, rosters, taxonomies, location information, and supporting documents.
  • Track submissions, payer requests, effective dates, unresolved issues, and enrollment completion.
  • Communicate payer participation and effective dates to Revenue Cycle, billing teams, Operations, and other authorized stakeholders.
  • Identify and escalate enrollment gaps that may delay billing, extend claim holds, contribute to timely-filing denials, or result in write-offs.
• Provider Records, Portals, and Data Maintenance
  • Maintain complete, organized, secure, and audit-ready provider files and internal tracking records.
  • Maintain organizational access and provider affiliations within Availity and other payer portals.
  • Manage CAQH profile maintenance, document uploads, authorizations, data updates, and required attestations.
  • Complete or coordinate payer-directory, roster, and portal attestations within required timeframes.
  • Process provider additions, changes, location updates, and terminations across internal records and external systems.
  • Protect portal credentials and ensure access is assigned, updated, and removed in accordance with organizational security practices.
• Licensure, Expirables, and Practice Agreement Oversight
  • Track professional licenses, DEA registrations, board certifications, malpractice coverage, controlled-substance registrations, and other required credentials.
  • Notify providers and leadership of upcoming expirations and follow up until updated documentation is received.
  • Maintain applicable practice agreements, supervision or collaboration documentation, and other requirements for advanced practice providers.
  • Escalate expired, suspended, incomplete, or inconsistent credentials before they affect provider scheduling, patient care, billing, HR, or compliance.
  • Coordinate updated documents with credentialing and payer enrollment vendors when changes affect active files or payer records.
• Facility, Service-Line, and Growth Support
  • Support provider and facility readiness for new locations.
  • Coordinate documentation associated with new service lines, additional providers, location changes, and organizational growth.
  • Maintain facility and provider enrollment timelines and communicate dependencies that may affect opening dates or billing readiness.
  • Assist with Medicare, Medi-Cal, Partnership HealthPlan, commercial payer, and other enrollment activities as assigned and within the contracted division of work.
• Vendor Management, Communication, and Reporting
  • Review vendor status reports, reconcile outstanding items, and hold vendors accountable to agreed turnaround times and deliverables.
  • Serve as the central communication hub for provider credentialing and enrollment matters.
  • Triage incoming correspondence, determine ownership, assign or route work, follow up on unresolved issues, and escalate barriers.
  • Prepare routine status reports and dashboards addressing active files, upcoming deadlines, credential expirations, enrollment status, vendor performance, and claims at risk.
  • Participate in workflow improvement, policy implementation, accreditation readiness, and internal audit activities.
  • Maintain confidentiality and handle provider information in accordance with organizational policy and applicable privacy and security requirements.

Requirements

• High school diploma or equivalent.
• Two (2) years of progressively responsible healthcare administrative, medical staff services, provider onboarding, payer enrollment, revenue cycle, human resources, or comparable coordination experience.
• Demonstrated ability to manage multiple deadlines, documents, stakeholders, and confidential records with accuracy.
• Experience using Microsoft Office applications and web-based portals, databases, or document-management systems.

Preferred Qualifications

• Associate degree in healthcare administration, business, health information management, or a related field; equivalent relevant experience may be considered.
• Experience with provider credentialing, privileging, recredentialing, payer enrollment, provider onboarding, medical staff services, CAQH, Availity, Medicare, Medi-Cal, Partnership HealthPlan, or commercial payer portals.
• Experience in an FQHC, Tribal health program, rural healthcare organization, multisite clinic, or other regulated healthcare setting.

Licenses & Certificates

• Valid BLS Certification
• Valid California Driver’s License

Working Environment & Physical Demands

Working Environment: Work is performed in a health clinic setting. The noise level in the work environment is usually low to moderate. Will work with blood-borne pathogens and will require OSHA training. This job routinely uses standard office equipment such as computers, telephones, photocopiers, and fax machines.

Physical Demands: While performing the duties of this job, the employee is regularly required to talk and hear. The employee frequently is required to stand, walk, sit, use hands to finger, handle, or feel; and reach with hands and arms. The employee is occasionally required to stoop. The employee must occasionally lift and/or move up to 25 pounds. Position may require exertion up to 20 pounds of force occasionally and/or up to 10 pounds of force frequently or constantly to lift, carry, push, pull or otherwise move objects. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.

Other Requirements

• Pre-employment drug testing and Department of Justice fingerprinting clearance through Federal, State, and Child Abuse Index are required and must be maintained throughout employment.
• Provide vaccination records to show proof of immunity for TB, Measles, Mumps, Rubella, Varicella, TDAP, and Hep B. If records are more than 10 years old, titers are required to confirm immunity.

Employment with Rolling Hills Clinic is at-will and may be terminated with or without cause or notice by either party.