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This is a hybrid role based in Riverside, CA. Onsite presence is required on a regular basis, with flexibility to work remotely based on business needs.
Mon - Fri (hours based on business needs)
R
Credentialing Specialist
Temecula, CAPosted 2 weeks ago
Full-timehybridmid
Job Description
Position Summary:
The Credentialing Specialist is responsible for supporting the end-to-end credentialing and recredentialing process for providers across multiple TINs and brands. This role ensures accurate, timely payer enrollment and maintenance of provider records while serving as a key administrative partner to the Senior Credentialing Specialist. The position plays a critical role in minimizing revenue delays and maintaining compliance with payer and regulatory requirements.
Key Responsibilities:
- Manage initial credentialing and recredentialing for providers with commercial and government payers
- Prepare and submit credentialing applications, ensuring completeness and accuracy
- Track application status and proactively follow up with payers to ensure timely processing
- Maintain provider records in credentialing systems and databases
- Monitor and manage expirables (licenses, certifications, malpractice insurance, etc.)
- Assist with payer roster submissions and directory updates
- Support enrollment for new providers, new locations, and additional TINs
- Serve as a liaison between internal departments (RCM, operations, compliance) and external payers
- Provide administrative support to the Senior Credentialing Specialist, including documentation management and reporting
- Identify and escalate issues that may impact provider enrollment or revenue cycle performance
- Contribute to process improvements and standardization efforts
Qualifications:
- 2+ years of credentialing or payer enrollment experience in a healthcare setting
- Knowledge of commercial and government payer credentialing requirements
- Experience working with multiple TINs and provider groups preferred
- Familiarity with credentialing systems (e.g., CAQH, PECOS, or similar platforms)
- Strong organizational skills and attention to detail
- Ability to manage multiple priorities and meet deadlines
- Effective communication and follow-up skills
Skills & Abilities:
- Detail-oriented and process-driven
- Strong problem-solving skills
- Ability to work independently and collaboratively
- Proactive and accountable
- Adaptable in a fast-paced, growing environment
This is a hybrid role based in Riverside, CA. Onsite presence is required on a regular basis, with flexibility to work remotely based on business needs.
Mon - Fri (hours based on business needs)