Credentialing and Provider Enrollment Specialist
About The Position
Chaparral Medical Group (CMG), in partnership with Akido Labs, is seeking a driven Credentialing / Provider Enrollment Specialist to join their team. This role is crucial for ensuring providers are credentialed and enrolled efficiently and accurately with health plans and hospitals, thereby guaranteeing uninterrupted patient access to care. The specialist will be part of a team focused on transforming the healthcare experience by reducing administrative burdens on medical providers and staff. CMG, with over 40 years of experience, serves over 250,000 patients in Southern California and is expanding its reach across the U.S., committed to providing accessible, high-quality healthcare.
Requirements
- 3+ years of experience in provider credentialing/enrollment.
- Strong knowledge of NCQA standards, payer requirements, and credentialing best practices.
- Excellent problem-solving and critical thinking skills, with the ability to resolve escalated issues.
- Exceptional organization skills, with sharp attention to detail and ability to manage multiple priorities.
- Strong written and verbal communication and interpersonal skills to collaborate cross-functionally and with external stakeholders.
Nice To Haves
- Bachelor’s degree in healthcare administration, business, or related field.
- Experience with credentialing/enrollment software and databases.
Responsibilities
- Filling out provider enrollment applications with health plans, Medicare, Medicaid and hospitals.
- Following up with health plans and hospitals on submitted applications.
- Solving complicated credentialing-related issues directly with IPAs and health plans.
- Maintaining a clean database of provider data and enrollment-related activities in MD Staff.
- Applying for license renewals.
- Communicating with providers on credentialing-related updates.
- Processing credentialing, re-credentialing, and privileging applications.
- Monitoring application timelines to prevent delays and resolve escalated issues.
- Maintaining high data quality for provider data and credentialing data.
- Following SOPs and policies for streamlined workflows and compliance.
- Maintaining compliance with state, federal, and payer-specific credentialing requirements.
- Acting as a liaison for external partners, including payers, hospitals, and credentialing verification organizations.
Benefits
- Health benefits include medical, dental and vision
- Life insurance
- Paid leaves
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
11-50 employees
