Credentialing Specialist

Position Summary

The Credentialing Specialist is responsible for supporting the end-to-end provider credentialing and privileging process to ensure healthcare providers meet all regulatory, accreditation, and organizational requirements. This role focuses on accurate verification, documentation management, and ongoing compliance while supporting efficient credentialing workflows and operational effectiveness.

The Credentialing Specialist works closely with internal teams and external stakeholders to ensure timely and compliant processing of provider credentialing and re-credentialing activities.

Key Duties and Responsibilities

• Support all credentialing activities to ensure effective operations and compliance with federal, state, payer, and organizational standards
• Complete initial credentialing and re-credentialing applications, ensuring accuracy, timeliness, and inclusion of all required documentation
• Review provider documentation, identify discrepancies, research issues, and ensure proper resolution and follow-up
• Process provider privileging requests in accordance with organizational policies and regulatory requirements
• Serve as a point of contact for credentialing and privileging inquiries from internal teams and external entities
• Track initial credentialing, reappointments, re-credentialing cycles, and expirable items to maintain compliance
• Review provider applications and supporting materials for completeness and eligibility prior to submission
• Prepare credentialing files for committee review and approval
• Ensure accurate collection, verification, and documentation of provider data in compliance with internal policies and audit standards
• Support contract acquisition and provider onboarding by coordinating credentialing requirements and documentation
• Maintain organized records and ensure all follow-up activities are completed within established timelines
• Assist with process improvements and workflow efficiencies within credentialing operations
• Perform additional administrative and operational duties as needed to support departmental goals

Qualifications

• Experience in healthcare credentialing, enrollment, or provider services
• Working knowledge of credentialing, privileging, and healthcare compliance requirements
• Familiarity with regulatory standards and accreditation guidelines
• Strong attention to detail and organizational skills
• Ability to manage sensitive and confidential information with discretion
• Effective written and verbal communication skills
• Ability to manage multiple tasks and meet deadlines in a fast-paced environment
• NO Staffing Credentialing Experience, provider only.

Compensation & Benefits

• Salary range: $60,000 - $65,000 annually, dependent on experience
• Health, vision, and dental insurance benefits
• Standard employer-sponsored benefits package

All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the California Fair Chance Act, City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, and Los Angeles County Fair Chance Ordinance.