Credentialing Specialist

Credentialing Specialist Rancho Health MSO, Inc - 4.0 Temecula, CA Job Details Full-time $25 - $30 an hour 5 hours ago Qualifications Record keeping Regulatory compliance Process improvement Mid-level Databases Administrative experience Medical administrative support Organizational skills Document management Escalation handling 2 years Healthcare compliance Communication skills

Full 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)