Credentialing Specialist

EHR Billing Credentialing Analyst

HealthRIGHT 360 gives hope, builds health, and changes lives for people in need by providing comprehensive, integrated, compassionate care that includes primary medical care, mental health services, and substance use disorder treatment.

This is a union-eligible position.

The required shift for this position is: Monday - Friday

HealthRIGHT 360, a family of programs, operates in 11 counties throughout California. Offering a comprehensive range of medical and behavioral health services, HealthRIGHT 360 serves marginalized communities, including primary care, mental health support, detoxification, residential and outpatient substance use disorder treatment, and transitional services tailored to individuals involved in the criminal justice system.

The Electronic Health Records (EHR) department is integral to our operations, ensuring that all electronic health record systems function optimally and that all users receive the necessary training and support. As a fast-paced, service-oriented department, we aim to empower all programs in delivering the best possible client services.

The EHR Billing Credentialing Analyst is responsible for coordinating, maintaining, and monitoring provider credentialing and enrollment processes within the electronic health record (EHR) system and associated payer platforms. This position works closely with clinical leadership, Human Resources, Compliance, Billing, and external agencies to ensure providers maintain active and compliant credentials, licenses, certifications, and payer enrollments required for service delivery and reimbursement.

This role includes maintaining provider records, tracking credentialing deadlines, supporting onboarding and recredentialing processes, validating provider data accuracy within EHR systems, troubleshooting credentialing-related system issues, and ensuring compliance with county, state, federal, and payer requirements. The EHR Billing Credentialing Analyst will also assist with implementations related to provider setup, workflows, and system integrations associated with credentialing and enrollment processes.

Key Responsibilities

• Provider Credentialing Maintenance: Maintain and organize provider credentialing records, licenses, certifications, DEA registrations, NPIs, and payer enrollment documentation within the EHR system.
• Credentialing & Recredentialing Coordination: Coordinate initial credentialing, recredentialing, and provider enrollment processes with payers, counties, and regulatory agencies.
• Provider Data Configuration: Configure and maintain provider profiles, specialties, service locations, supervising relationships, and credentialing-related information in the EHR system.
• Credential Monitoring: Monitor credential expiration dates and ensure timely renewals to maintain provider compliance and uninterrupted billing capabilities.
• Payer Enrollment Support: Prepare and submit enrollment applications and supporting documentation for provider participation with counties, managed care plans, and other funding entities.
• Data Validation & Auditing: Conduct regular audits of provider data and credentialing records to ensure accuracy, completeness, and compliance.
• Issue Resolution: Investigate and resolve credentialing discrepancies, missing documentation, enrollment delays, and provider setup issues.
• Help Desk Escalation Support: Serve as an escalation resource for credentialing-related EHR support requests and technical issues.
• Communication & Collaboration: Communicate and collaborate with EHR, Compliance, HR, Billing, Fiscal, and Clinical teams as well as the Counties to ensure provider records remain accurate and compliant.
• Meetings: Attend and participate in department, inter-team, and agency meetings as appropriate.
• Miscellaneous: Other duties as assigned.

Process

• Workflow Improvement: Utilize problem-solving skills to improve credentialing workflows, tracking systems, and provider onboarding processes.
• Implementations: Assist EHR leadership with credentialing-related implementations, provider onboarding workflows, and system enhancements for new programs or funding streams.

Intangibles

• Relationships: Develop and maintain effective working relationships with clinical leadership, HR, compliance teams, and external credentialing entities.
• Agency Philosophy and Mission: Incorporate agency philosophy and mission in all aspects of job performance.
• Confidentiality: Maintain confidentiality regarding clients, providers, employees, and operations of the agency in accordance with HIPAA and 42 CFR Part 2.
• Judgment: Exercise good judgment in the performance of duties and responsibilities.

Qualifications

Education, Experience, or Certification

• Minimum of 3 years' experience working in healthcare credentialing, provider enrollment, EHR systems, or healthcare administration OR
• Master's degree or higher.

Desired:

• Experience with provider credentialing and payer enrollment processes.
• Experience maintaining provider data within EHR systems and/or county systems.
• Experience with compliance tracking, audits, and documentation management.
• Experience with Help Desk or user support preferred.
• Knowledge of HIPAA and CFR 42.
• Familiarity with Medi-Cal, county behavioral health systems, and payer credentialing requirements preferred.

Knowledge and Skills

• High degree of accuracy, speed, and attention to detail.
• Ability to multitask on projects and daily tasks while maintaining effective communication.
• Ability to successfully prioritize.
• Ability to work efficiently and productively in an independent manner.
• Excellent verbal, written, and interpersonal skills.
• Integrity to handle sensitive information in a confidential manner.
• Strong organizational and documentation management skills.
• Desire to learn and eagerness to elevate the efficiency of the department and agency.

Competencies

• Provider Credentialing & Enrollment Management Coordinating and maintaining provider credentialing, payer enrollment, and recredentialing processes in compliance with regulatory and payer requirements.
• EHR Provider Configuration & Maintenance Ability to configure and maintain provider records, specialties, licenses, and credentialing-related information within the EHR system.
• Credential Monitoring & Compliance Proficiency in monitoring expiration dates, renewals, and compliance requirements to ensure uninterrupted provider eligibility and billing readiness.
• Documentation Review & Audit Readiness Ability to organize, review, and audit provider documentation to ensure accuracy, completeness, and compliance with agency and payer standards.
• Issue Resolution & Problem-Solving Strong analytical and problem-solving skills to investigate credentialing discrepancies, resolve enrollment issues, and improve workflow processes.
• Help Desk Support & Escalation Provide advanced support for credentialing-related EHR issues and assist users with troubleshooting and system navigation.
• Cross-Department Communication & Collaboration Effective communication and collaboration with EHR, HR, Compliance, Billing, Fiscal, and Clinical teams to support provider onboarding and maintenance.
• Workflow Improvement & Process Optimization Ability to identify inefficiencies and implement improvements to credentialing tracking systems and operational workflows.
• Confidentiality & Compliance Commitment to maintaining confidentiality regarding provider, client, and operational information in accordance with HIPAA and CFR 42 guidelines.

Background Check and Other Requirements

• Capable of obtaining and maintaining a satisfactory background check.
• Applicants must not be on parole or probation due to funding regulations. Qualified candidates with a criminal record will be considered for employment.
• Capable of meeting credential requirements, if applicable.
• Capable of meeting program requirements.

HealthRIGHT 360 is committed to fair and equitable compensation practices. Placement within the compensation range is based on factors such as relevant experience, education, credentials, internal equity, and organizational compensation practices. In addition to salary, HealthRIGHT 360 offers a comprehensive benefits package, subject to eligibility requirements.

The compensation range listed reflects the expected pay for this position based on the primary work location. Actual compensation may vary depending on geographic location and applicable state or local pay transparency requirements.

HealthRIGHT 360 is an equal opportunity employer committed to fostering a diverse, equitable, and inclusive workplace. We prohibit discrimination, harassment, and retaliation based on any characteristic protected by applicable federal, state, or local laws, including race, color, ancestry, national origin, religion, sex, pregnancy, gender identity, gender expression, sexual orientation, age, disability, medical condition, genetic information, veteran status, marital status, and any other protected characteristic. We are committed to providing equal employment opportunities through fair and equitable recruitment, hiring, compensation, development, and advancement practices.

We will consider for employment qualified applicants with arrest and conviction records.

Must complete a background check and Live Scan.