Credentialing Specialist

What You'll Do

• Review practitioner and organizational provider credentialing and recredentialing applications for completeness 
• Review and analyze credentialing documents, including education, residency and fellowship training, board certification and eligibility, licensure, professional work history, liability insurance, requests for clinical privileges, malpractice history, and accreditation
• Assess completeness of information and provider’s qualifications relative to established standards
• Determine appropriate verification and reference letters to be prepared for adequate processing of each individual application and reapplication
• Identify and flag adverse information from provider application materials for the purpose of conducting follow-up investigations
• Request facility site reviews from appropriate source (i.e. CalOptima, HealthNet, IEHP, etc) on applicable providers
• Responsible for completion of recredentialing files within 36-month timeframe
• Update new information as received via recredentialing process 
• Maintain and exceed quantity and quality goals and standards set by the department

Qualifications

• High school diploma or equivalent
• At least 1 year of experience in credentialing, provider enrollment, contracting or similar field

• Licensure, Certification, Registration: CPCS or CPMSM certification 
• Have 2-3 years’ credentialing experience within a managed care, hospital or CVO credentialing 

Environmental Job Requirements and Working Conditions

• Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis.  The office is located at 1600 Corporate Center Dr. Monterey Park, CA 91754. 
• The target pay range for this role is between $23.00 - $30.00 per hour. This salary range represents our national target range for this role. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.