Enterprise Credentialing Specialist: Enterprise Credentialing

Hoag • Newport Beach, CA

2d

About The Position

The Enterprise Credentialing Specialist is responsible for maintaining cooperation and compliance with regulatory, accrediting, and membership-based organizations. This role involves creating and executing credentialing processes for physicians, healthcare professionals, and sites, and assisting the Supervisor in ensuring adherence to all relevant policies, guidelines, regulations, and laws. The specialist will process applications and reappointment paperwork, collect and verify significant amounts of data, and maintain accurate databases for practitioners and facilities. Additionally, the role requires preparing records for audits, communicating with practitioners to ensure up-to-date records, and demonstrating behaviors consistent with core values and required standards.

Requirements

• High School diploma, GED, California High Proficiency or equivalent work experience
• Proficiency with Microsoft Office Products (Word, Excel, PowerPoint)

Nice To Haves

• Experience specific to NCQA standards preferred
• MD Staff experience preferred
• Proficiency with medical terminology preferred

Responsibilities

• Maintain regular cooperation and compliance with all regulatory, accrediting, and membership-based organizations.
• Create and carry out credentialing processes for physicians, other healthcare professionals, and sites.
• Assist the Supervisor in ensuring that all personnel and services adhere to facility and staff policies, department guidelines, regulations, and government laws.
• Process applications and reappointment paperwork, verifying completeness and accuracy.
• Collect and process significant amounts of verification and accreditation information.
• Maintain and update accurate databases for practitioners and facilities, including education, training, experience, and licensure information.
• Prepare records for regular auditing.
• Maintain close communication with practitioners to ensure records are up to date and consistent.
• Demonstrate behaviors consistent with core values and comply with all required standards.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED