Medical Contracting & Credentialing Specialist

Job Description

Job Description

Salary: $28-33

Overview

Pedes Orange County is seeking an experienced Contracting & Credentialing Specialist to manage the full lifecycle of provider credentialing, facility credentialing, and payor and ancillary contracting for our growing vascular practice. This role is the internal subject matter expert for all credentialing and contracting functions and works closely with clinical leadership, billing, and executive management to protect revenue, maintain compliance, and ensure uninterrupted provider participation across all payors and facilities.

This is a mid-level position requiring strong attention to detail, knowledge of healthcare contracting and credentialing processes, and the ability to manage multiple concurrent timelines without oversight.

Key Responsibilities

Provider Credentialing Payors, Facilities & Hospitals

• Manage end-to-end provider credentialing and re-credentialing with commercial payors, Medicare, Medi-Cal, and Medicare Advantage plans
• Process and track facility and hospital privilege applications for all providers
• Maintain CAQH, PECOS, NPI, DEA, board certifications, malpractice, and all provider credential documentation
• Monitor expiration dates and proactively initiate renewals to prevent lapses in billing eligibility or privileges
• Communicate credentialing status to billing, leadership, and facility contacts regularly
• Maintain organized, audit-ready credentialing files for all providers

Joint Commission & Facility Accreditation

• Support and maintain compliance with Joint Commission accreditation standards
• Prepare and organize documentation required for accreditation surveys and site visits
• Track accreditation timelines and coordinate internal readiness activities
• Serve as a point of contact for accreditation-related inquiries and follow-up

Payor Contracting Fee-for-Service & Ancillary

• Manage end-to-end contracting for fee-for-service payor agreements
• Negotiate and execute ancillary service contracts across all applicable service lines
• Track contract effective dates, fee schedules, and renewal windows
• Ensure all active contracts accurately reflect current participating providers
• Partner with billing to verify contracted rates are loaded correctly and reimbursements align with agreements
• Maintain a master contract repository with key terms, expiration dates, and amendment history

Payor Contract Renegotiation Support

• Assist leadership in preparing for and executing payor contract renegotiations
• Pull and organize reimbursement data, utilization reports, and payer performance metrics to support negotiation strategy
• Draft correspondence and track outstanding items through the renegotiation process
• Coordinate with legal or external consultants as needed during complex negotiations

Provider & Facility Licensing Renewals

• Oversee all provider license renewals including state medical licenses, DEA registrations, and specialty certifications
• Manage facility licensing renewals and ensure all operational licenses remain current and compliant
• Maintain a centralized renewal calendar with proactive alerts and escalation protocols
• Coordinate with providers and administration to gather required documentation ahead of deadlines

Medical Records Secondary Support

• Provide secondary support to the medical records function as needed
• Assist with record requests, release of information workflows, and documentation compliance
• Support audit preparation and medical record organization as directed

Qualifications

• 3+ years of experience in healthcare contracting, credentialing, or a combined role
• Demonstrated experience with payor credentialing (Medicare, Medi-Cal, commercial) and facility privileging
• Familiarity with Joint Commission accreditation standards and survey preparation
• Experience negotiating or supporting renegotiation of payor contracts
• Knowledge of fee-for-service and ancillary contracting processes
• Proficiency with CAQH, PECOS, NPI Registry, and credentialing management systems
• Strong organizational skills and ability to manage multiple deadlines independently
• Excellent written and verbal communication skills for payer, facility, and internal correspondence
• Healthcare billing knowledge and experience working alongside revenue cycle teams preferred

Education & Certification

• Bachelor's Degree in Healthcare Administration, Business, or related field (Preferred)
• Certified Provider Credentialing Specialist (CPCS) or Certified Medical Staff Coordinator (CMSC) (Preferred)

Schedule & Compensation

• MondayFriday, 40 hours/week
• In-office, Irvine CA 92614
• Pay: $28 $33/hr

Benefits

• Health, Dental & Vision Insurance
• 401(k)
• Paid Time Off