Credentialing Specialist

You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.


Job Summary


Our client is seeking a Credentialing Specialist to manage credentialing applications and maintain provider data accuracy for compliance with company, federal, and state standards.


Key Responsibilities

• Review and process initial and recredentialing applications for providers.
• Submit and manage enrollment applications with Medicare, Medicaid portals, CAQH, Availity, and other payor-specific platforms.
• Conduct primary source verification for education, licensure, and certifications according to regulatory standards.
• Identify and resolve inconsistencies in credentialing documentation.
• Maintain provider data across credentialing databases.
• Ensure proper use of tools such as Modio Health, CAQH, and PECOS.
• Communicate with providers and internal departments for required documents.
• Submit provider rosters and maintain records for credentialing agreements.
• Contribute to process improvements in credentialing operations.
• Prepare status reports and documentation audits as needed.
• Assist in file audits and respond to requests for credentialing data.
• Perform additional tasks as assigned by the Credentialing Manager.

Schedule:

• Monday-Friday 8:30am-5:00pm in-person

Qualifications

• High School Diploma Required - Bachelors preferred.
• 3-5 years of experience in Credentialing/Provider Enrollment.
• Experience with Medicare (PECOS), Medicaid (EPREP), and CAQH.

Experience

• 3-5 years in Credentialing/Provider Enrollment.
• Experience with EHR systems such as Modio.

Skills

• Proficiency with Medicare, Medicaid, and CAQH platforms.
• Strong communication and teamwork capabilities.

Benefits

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
• Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
• 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
• Short Term Disability Insurance.
• Term Life Insurance Plan.

Required Employment / Compliance Language


Medix provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type.


* We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).


Medix Overview:


With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we're dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.


* As a job position within our Revenue Cycle division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, handling financial and other payment data, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.