Credentialing and Provider Enrollment Specialist

The Opportunity

Are you driven to build the systems that keep healthcare running seamlessly? As a Credentialing / Provider Enrollment Specialist, you’ll be part of our credentialing/provider enrollment team to ensure providers are credentialed and enrolled quickly and accurately with health plans and hospitals — so patients always have uninterrupted access to care.

Credentialing/enrollment activities on this team include:

• Filling out provider enrollment applications with health plans, Medicare, Medicaid and hospitals.
• Following up with health plans and hospitals on submitted applications.
• Solve complicated credentialing-related issues directly with IPAs and health plans. 
• Maintaining a clean database of provider data and enrollment-related activities in MD Staff. 
• Applying for license renewals.
• Communicating with providers on credentialing-related updates. 

This is a hands-on role where you will work with the Credentialing Supervisor and fellow Provider Enrollment Coordinators to ensure all work is completed in a timely and accurate fashion. If you’re energized by improving processes and building a credentialing function that supports high-quality care, we’d love to meet you!

What You’ll Do

• Work amongst a team of credentialing/enrollment specialists to deliver accurate, timely, and compliant work - including completing credentialing/enrollment tasks. 
• Process credentialing, re-credentialing, and privileging applications to keep providers active and patient care uninterrupted.
• Solve enrollment-related issues as they arise, working directly with health plans to get them resolved. 
• Monitor application timelines to prevent delays and resolve escalated issues from staff, clinics, and providers.
• Maintain high data quality, including both provider data as well as credentialing data, like expiration dates, contact information, etc. 
• Follow SOPs and policies that are designed to streamline workflows and strengthen compliance.
• Maintain compliance with the state, federal, and payer-specific credentialing requirements.
• Act as a liaison for external partners, including payers, hospitals, and credentialing verification organizations.

Who You Are

• Bachelor’s degree in healthcare administration, business, or related field (preferred).
• 3+ years of experience in provider credentialing/enrollment.
• 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.
• 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.
• Experience with credentialing/enrollment software and databases (preferred).

Benefits

• Health benefits include medical, dental and vision
• Life insurance
• Paid leaves

Location

• This role is in-person in Pomona, CA.