Job Description
We are looking for a Credentialing Specialist to support a healthcare organization in California through a contract assignment. This position focuses on managing provider credentialing and enrollment activities, maintaining accurate records, and helping the organization stay aligned with payer and regulatory standards. The ideal candidate brings hands-on experience with credentialing workflows, strong follow-through, and the ability to work closely with providers, internal teams, and external partners.
Responsibilities:
• Manage initial credentialing, recredentialing, and enrollment activities for physicians and other clinical staff across a range of payer networks and programs.
• Communicate with insurance brokers regarding liability coverage updates and ensure related documentation remains current.
• Monitor credentialing standards and ongoing maintenance obligations for relevant healthcare entities, keeping records aligned with applicable requirements.
• Prepare, collect, and submit enrollment packets, supporting documents, and payer-specific forms for public and commercial health plans.
• Maintain and update credentialing and enrollment information within CredentialStream and VerityStream to ensure complete and accurate provider data.
• Support audit readiness and site visit preparation by organizing files, verifying documentation, and responding to credentialing-related requests.
• Conduct routine follow-up between credentialing cycles to track expirations, renewals, and changes involving licenses and other compliance-related records.
• Coordinate required classes, employee enrollment activities, and completion tracking in partnership with internal stakeholders, including Human Resources.
• Work directly with providers to gather needed information, answer questions, and guide them through credentialing and enrollment processes.• At least 3 years of experience in credentialing, provider enrollment, or a closely related healthcare administrative function.
• Demonstrated knowledge of provider credentialing, physician credentialing, and recredentialing procedures.
• Experience handling payer enrollment documentation for both commercial and government-affiliated health plans.
• Familiarity with credentialing databases or platforms such as CredentialStream and VerityStream.
• Strong attention to detail with the ability to manage sensitive records, deadlines, and compliance-related data accurately.
• Effective communication skills for working with providers, brokers, payers, and cross-functional internal teams.
• Ability to interpret credentialing requirements, maintain organized documentation, and support audits or site reviews.
