Credentialing Specialist

Description We are looking for a Credentialing Specialist to support provider and clinic staff credentialing operations for a Contract position based in Fresno, California. This role is responsible for coordinating the full credentialing lifecycle, helping ensure practitioners and clinical staff meet regulatory, payer, and accreditation standards. The ideal candidate brings strong attention to detail, sound knowledge of provider enrollment and reappointment processes, and the ability to keep records accurate and timelines on track while working with internal leaders and external organizations.

Responsibilities:

• Manage end-to-end credentialing, recredentialing, and privileging activities for providers and clinical staff, ensuring records remain complete and current.
• Prepare, submit, and monitor credentialing applications, following up with health plans, facilities, and agencies to keep approvals moving forward.
• Maintain organized documentation for licenses, certifications, malpractice coverage, and other required compliance materials for all applicable providers.
• Monitor expiration dates for licenses, certifications, liability coverage, and related credentials, and coordinate timely renewals to avoid lapses.
• Update and maintain provider profiles within credentialing platforms and internal databases, ensuring data accuracy across systems and directories.
• Coordinate renewal appointments for clinic staff and track required timelines to support uninterrupted compliance.
• Process privileging and reappointment requests for affiliated healthcare facilities when needed and verify supporting documentation.
• Review provider listings and directory information for accuracy, correcting demographic and practice location details with payers and partner entities as necessary.
• Provide credentialing and privileging verifications and assist with audits, accreditation activities, and other compliance-related assignments.
• Participate in training and carry out additional duties as assigned while demonstrating efficient use of time and resources. Requirements
• At least 3 years of experience in credentialing, provider enrollment, physician credentialing, or recredentialing operations.
• Demonstrated knowledge of credentialing workflows, application processing, and document management for licensed clinical professionals.
• Familiarity with California regulatory expectations and common payer, agency, and accreditation requirements related to provider credentialing.
• Experience maintaining accurate provider records, tracking expirations, and managing deadlines across multiple files or databases.
• Ability to work effectively with providers, leadership, health plans, agencies, and external facilities to resolve credentialing matters.
• Strong organizational skills and close attention to detail, with the ability to handle confidential information appropriately.
• Proficiency with online credentialing systems, database updates, and verification processes.
• Clear written and verbal communication skills for follow-up, coordination, and status reporting.

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