Position Summary:
The Credentialing Specialist is responsible for supporting the end-to-end credentialing and recredentialing process for providers across multiple TINs and brands. This role ensures accurate, timely payer enrollment and maintenance of provider records while serving as a key administrative partner to the Senior Credentialing Specialist. The position plays a critical role in minimizing revenue delays and maintaining compliance with payer and regulatory requirements.
Key Responsibilities:
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Manage initial credentialing and recredentialing for providers with commercial and government payers
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Prepare and submit credentialing applications, ensuring completeness and accuracy
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Track application status and proactively follow up with payers to ensure timely processing
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Maintain provider records in credentialing systems and databases
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Monitor and manage expirables (licenses, certifications, malpractice insurance, etc.)
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Assist with payer roster submissions and directory updates
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Support enrollment for new providers, new locations, and additional TINs
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Serve as a liaison between internal departments (RCM, operations, compliance) and external payers
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Provide administrative support to the Senior Credentialing Specialist, including documentation management and reporting
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Identify and escalate issues that may impact provider enrollment or revenue cycle performance
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Contribute to process improvements and standardization efforts
Qualifications:
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2+ years of credentialing or payer enrollment experience in a healthcare setting
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Knowledge of commercial and government payer credentialing requirements
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Experience working with multiple TINs and provider groups preferred
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Familiarity with credentialing systems (e.g., CAQH, PECOS, or similar platforms)
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Strong organizational skills and attention to detail
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Ability to manage multiple priorities and meet deadlines
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Effective communication and follow-up skills
Skills & Abilities:
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Detail-oriented and process-driven
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Strong problem-solving skills
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Ability to work independently and collaboratively
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Proactive and accountable
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Adaptable in a fast-paced, growing environment
This is a
hybrid role based in Riverside, CA. Onsite presence is required on a regular basis, with flexibility to work remotely based on business needs.
