The Opportunity

Are you driven to build the systems that keep healthcare running seamlessly? As a Credentialing Specialist, you’ll be part of our credentialing/provider enrollment team to ensure providers are credentialed and enrolled quickly and accurately with health plans and hospitals — so patients always have uninterrupted access to care.

Credentialing/enrollment activities on this team include:

Filling out provider enrollment applications with health plans, Medicare, Medicaid and hospitals.
Following up with health plans and hospitals on submitted applications.
Solve 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.

This is a hands-on role where you will work with the Credentialing Supervisor and fellow Credentialing Coordinators to ensure all work is completed in a timely and accurate fashion. If you’re energized by improving processes and building a credentialing function that supports high-quality care, we’d love to meet you!

What You’ll Do

Work amongst a team of credentialing/enrollment specialists to deliver accurate, timely, and compliant work - including completing credentialing/enrollment tasks.
Process credentialing, re-credentialing, and privileging applications to keep providers active and patient care uninterrupted.
Solve enrollment-related issues as they arise, working directly with health plans to get them resolved.
Monitor application timelines to prevent delays and resolve escalated issues from staff, clinics, and providers.
Maintain high data quality, including both provider data as well as credentialing data, like expiration dates, contact information, etc.
Follow SOPs and policies that are designed to streamline workflows and strengthen compliance.
Maintain compliance with the state, federal, and payer-specific credentialing requirements.
Act as a liaison for external partners, including payers, hospitals, and credentialing verification organizations.

Who You Are

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).

Benefits

Health benefits include medical, dental and vision
Life insurance
Paid Leaves

Location

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

Description