Credentialing Specialist

Credentialing Specialist Position Overview

Ultimate Staffing Services is actively seeking a dedicated Credentialing Specialist to join a dynamic team in California. This role requires someone who is detail-oriented and has a passion for ensuring compliance and maintaining high standards within the healthcare sector. The ideal candidate will be responsible for the full credentialing lifecycle and manage payor enrollment, facility licensing, and more. This position is integral to maintaining compliance with regulatory bodies and ensuring a seamless onboarding experience for providers.

Responsibilities

General Compliance

Ensures the organization maintains compliance with HRSA, FTCA, CMS, NCQA, and other applicable regulatory and accrediting bodies, facilitating timely provider onboarding and payor enrollment. Responsible for facility, site, and service-line licensing, ensuring timely renewals, accurate postings, and alignment with payer/site enrollments.

Credentialing & Privileging

• Manage the full credentialing lifecycle for licensed providers and other credentialed staff, including initial credentialing, primary source verification, and recredentialing every two years.
• Coordinate the privileging process, ensuring all privilege requests are complete, appropriately reviewed, and approved by the Board of Directors.
• Maintain accurate and complete provider files, credentialing database, and credentialing software systems.
• Track and verify license, DEA, BLS, malpractice insurance, board certifications, NPDB, and other required documents to ensure ongoing compliance.
• Coordinate and track annual peer review results and ensure the Chief Medical Officer (CMO) reviews and incorporates them into the recredentialing and reprivileging process.
• Prepare reports for the Quality Committee, Medical Executive Committee, and Board of Directors regarding credentialing and privileging status.

Payor Enrollment

• Manage enrollment and re-enrollment with all contracted health plans (Medicaid, Medicare, and commercial insurers).
• Prepare, submit, and track all enrollment applications, including provider adds, terminations, demographic updates, and reassignment of benefits.
• Maintain accurate payor rosters and CAQH profiles for all providers.
• Monitor effective dates and ensure billing and reimbursement are not delayed.
• Collaborate with the billing and revenue cycle teams to resolve enrollment-related claim denials.

Facility Licensing

• Maintain a comprehensive inventory of all organizational facility, site, and service-line licenses/permits/registrations, including license numbers, effective/expiration dates, scope of services, locations, and required postings.
• Prepare, submit, and track initial applications and renewals for facility and service-line licenses (e.g., clinic license, CLIA, radiology, lab, DME, pharmacy, and local business licenses), preventing lapses and interruptions in operations.
• Manage Medicare/Medicaid revalidations and state enrollment renewals for facilities.
• Maintain a centralized, audit-ready license repository and ensure current postings at each site; respond to payer, regulator, or accreditor requests within stated timelines.

Requirements

• Experience in a related role is preferred, but not required.
• Strong organizational and communication skills.
• Attention to detail and ability to manage multiple tasks efficiently.

Work Hours

1st Shift: Monday to Friday

Benefits

Competitive pay, ranging from $24 to $26 per hour, depending on experience.

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, Los Angeles County Fair Chance Ordinance, and San Francisco Fair Chance Ordinance.