Credentialing Specialist

Pacific Clinics • Arcadia, CA

14d

About The Position

The Credentialing Specialist ensures healthcare professionals within the organization are properly credentialed and compliant with state, federal, and organizational regulations. The role verifies workforce qualifications, maintains accurate and current records, and ensures timely re-credentialing to support the quality of care provided by the organization.

The position is scheduled Monday through Friday, 8:00 a.m. to 4:30 p.m. Initial compensation ranges from $23 to $28.23 per hour, depending on experience, location, and internal equity considerations. Eligible employees may receive bilingual differentials. Benefits eligibility begins on day one and includes medical, dental, and vision coverage, a 401(k) employer match of up to 4%, and competitive time-off plans, subject to eligibility requirements based on employment status.

Requirements

• Associate degree (AA/AS) in healthcare administration, business, or a related field and at least two years of relevant experience, or an equivalent combination of education and experience.
• At least two years of experience in credentialing within a healthcare or managed care setting.
• Working knowledge of credentialing standards and regulatory bodies such as NCQA, CMS, and The Joint Commission.
• Experience using credentialing databases or platforms such as CAQH, Verity, or MD-Staff.
• Proficiency in Microsoft Office applications, including Excel, Outlook, and Word.
• Strong organizational, analytical, and interpersonal skills.
• Ability to handle sensitive data with discretion and confidentiality.
• Willingness to obtain Certified Provider Credentialing Specialist (CPCS) certification within one to two years if not already certified.
• Strong attention to detail and accuracy; effective time management; ability to meet strict deadlines; clear, professional, and respectful communication; sound judgment when resolving issues or discrepancies; ability to work independently and contribute to team goals; flexibility with changing priorities and processes; reliability and accountability; and ability to build positive relationships with internal staff and external providers.

Responsibilities

• Conduct primary source verifications of licensure, board certifications, education, and work history.
• Track and manage re-credentialing timelines to ensure timely renewal and compliance.
• Maintain and update credentialing databases and records accurately and confidentially.
• Communicate with providers and internal departments regarding credentialing status and documentation needs.
• Collaborate with compliance and quality teams to ensure adherence to standards such as NCQA, CMS, and The Joint Commission.
• Respond to credentialing-related inquiries and audit requests.
• Assist in preparing files for credentialing committee review and maintain records of decisions.

Benefits

• Medical insurance
• Dental insurance
• Vision insurance
• 401(k) employer match up to 4%
• Competitive time-off plans
• Possible bilingual differential: up to 7.5% for qualifying direct-service roles or up to $80 per month for qualifying non-direct-service roles

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree