Credentialing Coordinator

Serve the People•Santa Ana, CA

18h

About The Position

As a pivotal member of the Human Resources team, the Credentialing Coordinator is instrumental in managing the full scope of credentialing, re-credentialing, privileging, and enrollment processes for healthcare professionals, providers, and allied health professionals. This role is essential to ensuring provider readiness, uninterrupted patient access to care, and compliance with all applicable federal, state, payer, HRSA, and organizational standards. The Credentialing Coordinator role is essential in upholding the highest standards by ensuring all credentials are accurately maintained within internal databases and physical records. The position requires a detail-oriented individual who can work independently while also collaborating effectively within a dynamic team environment. The Credentialing Coordinator will be responsible for verifying qualifications, licenses, certifications, and work history, as well as monitoring expiration dates and ensuring timely renewals. This role also plays a key part in maintaining compliance with regulatory agencies, accreditation standards, and internal policies, while serving as a liaison between providers, payers, and various departments across the organization.

Requirements

High school diploma or equivalent required
Minimum of two (2) years of credentialing, provider enrollment, medical staff services, healthcare administration, or related experience required.
Working knowledge of HRSA Health Center Program requirements, Medi-Cal, Medicare, PECOS, DHCS enrollment systems, and managed care credentialing standards required.
Strong organizational skills with exceptional attention to detail and ability to manage multiple deadlines simultaneously.
Excellent written and verbal communication skills with the ability to interact professionally with providers, executives, agencies, and staff.
Ability to maintain discretion and handle sensitive confidential information.

Nice To Haves

Associate’s or Bachelor’s degree in Healthcare Administration, Business Administration, Human Resources, or related field preferred.
Prior experience in a Federally Qualified Health Center (FQHC), community clinic, IPA, medical group, or multi-specialty healthcare environment strongly preferred.
Experience with CAQH, NPPES, PECOS, payer portals, credentialing software (MedTrainer) and provider data management systems preferred.
Knowledge of California provider licensure boards, furnishing numbers, supervising/collaborative agreements, and scope of practice requirements preferred.
Certified Provider Credentialing Specialist (CPCS) or similar certification preferred but not required.
Spanish speaking, preferred.

Responsibilities

Coordinate and manage all initial credentialing, re-credentialing, privileging, and provider data maintenance processes for physicians, nurse practitioners, physician assistants, dentists, behavioral health providers, optometrists, pharmacists, and allied health professionals.
Manage provider enrollment, revalidation, roster maintenance, and demographic updates with Medi-Cal Managed Care Plans, PAVE, Medicare, PECOS, commercial health plans, IPA networks, and other contracted entities to ensure uninterrupted reimbursement and participation.
Maintain provider files and documentation in alignment with HRSA Health Center Program requirements, operational site visit readiness standards, and scope of project requirements.
Conduct timely verification of professional licenses, DEA registrations, board certifications, education, training, NPIs, malpractice coverage, and employment history through primary source methods.
Maintain complete, accurate, and audit-ready credentialing files in electronic and physical formats. Ensure documentation is current and readily accessible for review.
Track expiration dates for licenses, DEA, CPR/BLS, malpractice insurance, board certifications, furnishing numbers, and related credentials. Provide timely follow-up to ensure no lapses occur.
Assist in maintaining provider privileges, practice agreements, standardized procedures, and scope documentation consistent with clinical services offered.
Conduct routine monitoring of OIG, SAM, Medi-Cal Suspended and Ineligible Provider lists, NPDB, and licensing boards for sanctions or disciplinary actions.
Partner with Medical, Dental, Behavioral Health, Vision, Operations, and Compliance teams to ensure providers are fully onboarded and operationally ready.
Coordinate credentialing-related onboarding requirements for newly hired providers to support timely start dates and patient scheduling readiness.
Collaborate with MedTrainer administration to maintain provider credential files, training assignments, policy acknowledgments, compliance documentation, and readiness for audits or surveys.
Assist with uploading, tracking, and maintaining licenses, certifications, attestations, and required provider documents within MedTrainer or other compliance management systems.
Keep the credentialing database meticulously updated, reflecting the most current information.
Prepare regular reports regarding enrollment status, credential expirations, outstanding items, payer approvals, and provider readiness metrics.
Stay informed of changes impacting FQHCs, including CMS, DHCS, HRSA, NCQA, and payer credentialing requirements. Update internal workflows and procedures as needed.
Participate in internal audits, readiness reviews, and process improvement initiatives related to credentialing accuracy, turnaround times, and compliance performance.
Participate in cross-training to support departmental continuity and assist with related HR or provider administration functions as needed.
Maintain strict confidentiality and comply with HIPAA and all privacy standards when handling provider, employee, and patient-related information.
Perform additional responsibilities as assigned by executive leadership and administration.