About this role
Credentialing Specialist
A healthcare company is looking for an experienced Credentialing Specialist to lead credentialing and provider data activities for a healthcare organization in Long Beach, California. The Credentialing Specialist is responsible for managing provider onboarding, recredentialing, payer enrollment support, and provider record maintenance while ensuring compliance with regulatory, accreditation, and health plan requirements. The Credentialing Specialist will also collaborate with internal teams to improve workflows, maintain audit readiness, and promote accurate, consistent credentialing practices.
Key Responsibilities
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Manage day-to-day credentialing activities for providers, including initial appointments, reappointments, and related follow-up tasks.
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Coordinate provider onboarding, recredentialing cycles, payer enrollment support, and privileging documentation to ensure timely processing.
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Maintain compliance with accreditation standards, delegated credentialing requirements, and applicable state and federal regulations.
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Review credentialing files, provider rosters, and supporting documentation for completeness, accuracy, and timely updates.
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Monitor credentialing volume, track turnaround times, and help resolve issues that may delay provider processing.
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Conduct routine audits of credentialing records and assist with preparation for internal and external audits or delegated reviews.
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Partner with leadership and cross-functional teams to support process improvements, policy updates, and reporting needs.
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Maintain provider data integrity across systems to support accurate reporting, downstream operations, and compliance requirements.
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Benefits: Health, Dental, Vision, 401k, and Sick Time Off.
Qualifications
- Associate’s or Bachelor’s degree in Healthcare Administration, Business Administration, or a related field preferred.
- 2+ years of experience in healthcare credentialing, provider enrollment, or provider data management.
- Working knowledge of provider onboarding, recredentialing, payer enrollment, and credentialing file maintenance.
- Familiarity with delegated credentialing requirements, accreditation standards, and applicable state and federal regulations.
- Experience reviewing provider documentation for accuracy, completeness, and compliance.
- Proficiency with credentialing software, provider databases, and Microsoft Office