We are looking for a Credentialing Specialist to support provider enrollment, credentialing, and compliance activities for a healthcare organization in California. This contract position requires someone who can manage documentation, maintain accurate records, and work closely with providers, payers, and internal teams to keep credentialing activities on schedule. The ideal candidate brings strong knowledge of credentialing processes, recredentialing requirements, and provider data management within a regulated healthcare environment.
Responsibilities:
- Manage credentialing and recredentialing activities for physicians and other clinical staff, ensuring all submissions and renewals are completed accurately and on time.
- Prepare and collect enrollment applications, supporting forms, and required documentation for submission to commercial and government payers.
- Maintain current provider information in credentialing and enrollment systems, including ongoing updates to records tied to licensure, compliance, and participation status.
- Monitor deadlines between credentialing cycles and follow up proactively to keep provider files complete and audit-ready.
- Support regulatory reviews, audits, and site visits by organizing documentation and responding to credentialing-related requests.
- Develop, update, and maintain policies and procedures that align with credentialing standards and organizational requirements.
- Communicate with insurance representatives and brokers regarding liability coverage updates and related documentation.
- Partner with providers and internal departments, including Human Resources, to gather required information, track completion items, and support enrollment-related activities.
- At least 3 years of experience in healthcare credentialing, provider enrollment, or a closely related function.
- Demonstrated knowledge of provider credentialing, physician credentialing, and recredentialing processes.
- Experience working with payer enrollment documentation for private insurance plans and public health programs.
- Strong attention to detail with the ability to manage sensitive records, deadlines, and compliance data accurately.
- Proficiency in credentialing databases or similar tracking systems used for provider information management.
- Effective communication skills for coordinating with providers, payers, brokers, and cross-functional internal teams.
- Ability to interpret credentialing requirements, maintain documentation standards, and support audit readiness.