Credentialing Specialist

Rancho Health MSO, Inc•Temecula, CA

15h•Hybrid

About The Position

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.

Requirements

2+ years of credentialing or payer enrollment experience in a healthcare setting
Knowledge of commercial and government payer credentialing requirements
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

Nice To Haves

Experience working with multiple TINs and provider groups preferred

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