Credentialing Specialist

Ultimate Staffing Services is actively seeking a dedicated Credentialing Specialist to join a dynamic team in California. This role requires someone who is detail-oriented and has a passion for ensuring compliance and maintaining high standards within the healthcare sector.

Responsibilities

• General Compliance: Ensures the organization maintains compliance with HRSA, FTCA, CMS, NCQA, and other applicable regulatory and accrediting bodies, facilitating timely provider onboarding and payor enrollment. Responsible for facility, site, and service-line licensing, ensuring timely renewals, accurate postings, and alignment with payer/site enrollments.
• Credentialing & Privileging:
  • Manage the full credentialing lifecycle for licensed providers and other credentialed staff, including initial credentialing, primary source verification, and recredentialing every two years.
  • Coordinate the privileging process, ensuring all privilege requests are complete, appropriately reviewed, and approved by the Board of Directors.
  • Maintain accurate and complete provider files, credentialing database, and credentialing software systems.
  • Track and verify license, DEA, BLS, malpractice insurance, board certifications, NPDB, and other required documents to ensure ongoing compliance.
  • Coordinate and track annual peer review results and ensure the Chief Medical Officer (CMO) reviews and incorporates them into the recredentialing and reprivileging process.
  • Prepare reports for the Quality Committee, Medical Executive Committee, and Board of Directors regarding credentialing and privileging status.
• Payor Enrollment:
  • Manage enrollment and re-enrollment with all contracted health plans (Medicaid, Medicare, and commercial insurers).
  • Prepare, submit, and track all enrollment applications, including provider adds, terminations, demographic updates, and reassignment of benefits.
  • Maintain accurate payor rosters and CAQH profiles for all providers.
  • Monitor effective dates and ensure billing and reimbursement are not delayed.
  • Collaborate with the billing and revenue cycle teams to resolve enrollment-related claim denials.
• Facility Licensing:
  • Maintain a comprehensive inventory of all organizational facility, site, and service-line licenses/permits/registrations, including license numbers, effective/expiration dates, scope of services, locations, and required postings.
  • Prepare, submit, and track initial applications and renewals for facility and service-line licenses (e.g., clinic license, CLIA, radiology, lab, DME, pharmacy, and local business licenses), preventing lapses and interruptions in operations.
  • Manage Medicare/Medicaid revalidations and state enrollment renewals for facilities.
  • Maintain a centralized, audit-ready license repository and ensure current postings at each site; respond to payer, regulator, or accreditor requests within stated timelines.

Requirements

• Experience in a related role is preferred, but not required.
• Strong organizational and communication skills.
• Attention to detail and ability to manage multiple tasks efficiently.

Schedule

1st Shift: Monday to Friday

Pay

Competitive pay, ranging from $24 to $26 per hour, depending on experience.