Responsibilities
- Complete credentialing, re-credentialing, and privileging applications to keep providers active and patient care uninterrupted.
- Complete provider enrollment applications and follow up with health plans, hospitals, Medicare, and Medicaid on submitted applications.
- Resolve enrollment-related issues as they arise, working directly with health plans and IPAs.
- Apply for license renewals and maintain accurate expiration tracking.
- Maintain high data quality in MD Staff, including provider data, expiration dates, and contact information.
- Maintain compliance with state, federal, and payer-specific credentialing requirements.
- Act as a liaison for external partners, including payers, hospitals, and credentialing verification organizations.
- Support MSO operations by processing credentialing applications and performing primary source verification in a timely and accurate manner.
- Serve as the primary subject matter expert for credentialing specialists, answering day-to-day questions and providing hands-on guidance.
- Own and manage the credentialing inbox, ensuring all incoming communications are triaged, tracked, and resolved in a timely manner.
- Act as the escalation point for issues raised by clinics, providers, and internal teams — resolving them quickly and accurately.
- Partner with the Credentialing leadership on special projects, process improvement initiatives, and departmental goals as needed.
- Support onboarding of new credentialing specialists by providing training on workflows, systems, and payer requirements.
- Provide coverage and continuity support for complex or time-sensitive credentialing tasks when needed.
Requirements
- 4+ years of experience in provider credentialing (strongly preferred)
- 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.
- Comfortable guiding and supporting peers in a fast-paced environment.
- 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.
Nice to Have
- Bachelor’s degree in healthcare administration, business, or related field.
- Experience with credentialing software and databases.
Benefits
- Health benefits include medical, dental and vision
- 401K
- Life insurance
- Wellness benefit
Work Arrangement
On-site
Additional Information
- This role is in-person in Pomona Valley.
