Credentialing Specialist

Position Title Credentialing Specialist Reporting Relationship Program Director Summary Community Solutions (CS) is a well-established non‑profit agency located in Santa Clara County and surrounding areas. CS provides prevention, intervention, treatment, and residential services to thousands of clients annually with a focus on mental health, substance abuse, trauma, and domestic violence. The Credentialing Specialist works closely with human resources, clinical leaders, billing, and external agencies to provide timely onboarding, credentialing and provider readiness. Qualifications Education and Experience : Associate degree or equivalent experience and a minimum of 2 years of administrative work, preferably in healthcare credentialing, provider enrollment, or compliance. Preferred Education : Bachelor’s degree in healthcare administration, business administration, or related field. Knowledge : Medi-Cal, Medicare, provider enrollment and credentialing processes; familiarity with NPPES, PAVE, CAQH ProView, exclusion list monitoring, and other payer systems. Must receive a criminal records clearance as required by state licensing regulations. Must possess a valid California driver’s license and maintain a clean driving record. Must have a personal automobile to perform routine job duties. Responsibilities Manage the full credentialing and re‑credentialing lifecycle for human service providers and designated clinical staff. Conduct primary source verification of licenses, certifications, education, training, and work history. Process and maintain provider enrollment, revalidation, and credentialing applications with Medi‑Cal, Medicare, county systems, commercial payers and other regulatory entities. Monitor licensure, certification, enrollment and credential expiration dates and maintain tracking systems to ensure timely renewals. Maintain accurate, complete, and up‑to‑date credentialing records and databases in accordance with agency policies and regulatory standards. Coordinate with human resources, clinical leadership, billing, systems/IT, and program staff to support onboarding, transfers, role changes and ongoing credentialing compliance. Assist providers and staff with obtaining and maintaining credentialing identifiers such as NPI numbers, taxonomy assignments and other enrollment requirements. Respond to credentialing related inquiries from staff, providers, payers, auditors and regulatory agencies. Prepare and distribute credentialing reports, compliance updates, audit documentation and status summaries for leadership and stakeholders. Conduct routine audits of credentialing records and support internal and external compliance reviews. Identify, investigate and resolve discrepancies, missing documentation and enrollment delays; escalate complex matters as appropriate. Monitor changes to credentialing, licensing and payer requirements and recommend updates to workflows or procedures. Use credentialing software, payer portals, CAQH ProView, Microsoft Office and related systems for documentation and reporting. Maintain strong organizational skills, attention to detail, independent judgment and the ability to manage multiple deadlines. Promote a collaborative, culturally responsive and solution‑focused work environment. Provide backup and support to the Quality Assurance Administrator and assist with special projects and assigned duties. Benefits 100% of HMO healthcare premiums paid by Community Solutions for full‑time employees and eligible dependent children. 3 weeks of paid vacation during the first year of employment. 13 paid holidays, including 2 floating holidays. 96 hours of sick time per year (8 hours per month). 5% matching on a 403(b) retirement plan after one year of employment. Longevity bonuses, generous family medical leave, student loan forgiveness program, staff learning and development opportunities. Equal Employment Opportunity Community Solutions is deeply committed to diversity, equity and inclusion. We provide equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or veteran status. Candidates from all backgrounds are encouraged to apply. Physical Requirements Sit for extended periods; frequently stand and walk; normal manual dexterity and eye‑hand coordination; lift and move objects up to 25 lbs.; use of office equipment including computer, telephone, calculator, copier, and fax; corrected hearing and vision to normal range. Work Environment and Location The position is based in Gilroy, CA, and requires a hybrid work schedule with occasional travel to the Gilroy or San Jose office and availability for evening or weekend work. Special Requirements Must receive a criminal records clearance as required by licensing regulations. Must possess a valid California driver’s license, current car insurance and a good driving record. Requires an automobile for routine duties. Requires full COVID‑19 vaccination, unless a reasonable accommodation has been approved. Legal and Compliance Candidates must be legally authorized to work as an employee in the United States without visa sponsorship. This job description outlines primary duties and qualifications; actual responsibilities may be modified as needed to accommodate individuals with disabilities. #J-18808-Ljbffr