Medical Credentialing Specialist
Job Description
You Shouldn’t have to navigate your job search alone, wonder where you stand, or settle for a position that isn't the right fit and with APS, you won’t
APS is seeking a detail-oriented and highly organized Medical Credentialing Specialist to join our clients healthcare team. This position is responsible for managing the credentialing and recredentialing process for physicians and allied health professionals, ensuring compliance with federal, state, payer, and accreditation requirements. The ideal candidate has exceptional attention to detail, strong organizational skills, and the ability to manage multiple deadlines in a fast-paced environment.
Location: Salida, CA
Pay Rate: $22-$24/hr + 60 day bonus
Requirements:
- High school diploma or equivalent required; Associate's or Bachelor's degree preferred.
- Minimum of 1 year of medical credentialing, provider enrollment, or healthcare administration experience preferred.
- Knowledge of provider credentialing, privileging, and payer enrollment processes.
- Familiarity with Medicare, Medicaid, commercial insurance carriers, and credentialing standards.
- Experience using credentialing software, CAQH, PECOS, and provider enrollment portals.
- Experience in a physician practice, hospital, medical group, or healthcare management organization preferred.
- Knowledge of electronic medical records (EMR) and healthcare information systems.
- Proficiency in Microsoft Office, including Excel, Word, and Outlook.
- Excellent written and verbal communication skills.
Responsibilities:
- Coordinate the initial credentialing, recredentialing, and privileging process for healthcare providers.
- Prepare, submit, and track credentialing applications with commercial insurance carriers, Medicare, Medicaid, and other payer organizations.
- Verify provider education, training, licensure, certifications, work history, malpractice coverage, and professional references.
- Monitor provider licenses, certifications, DEA registrations, malpractice insurance, and other required credentials to ensure timely renewals.
- Maintain accurate and up-to-date provider records in credentialing databases and electronic filing systems.
- Follow up with insurance carriers and credentialing organizations to resolve application issues and expedite approvals.
- Ensure compliance with NCQA, CMS, Joint Commission, state regulations, and payer-specific credentialing requirements.
- Work closely with physicians, practice managers, HR, and administrative staff to obtain required documentation.
- Respond to credentialing audits and maintain complete, audit-ready files.
- Generate reports and provide status updates on credentialing activities and provider enrollment.
- Key Competencies
- Detail-oriented and accurate
- Strong organizational and time management skills
- Analytical problem-solving abilities
- Deadline-driven with strong follow-through
- Excellent customer service and communication
- Ability to work independently and collaboratively
- High level of integrity and confidentiality
Meet Your Recruiter
Candace Abell
Sr. Staffing Consultant
Born and raised in Fresno, Candace has been a Central Valley girl from the start. She attended Fresno State University and was a member of Kappa Kappa Gamma Sorority. After relocating to Modesto, Candace started her family and her career in health care staffing. Candace knew almost instantly that she had found her calling- finding the right person for the perfect practice! Candace has been a pillar in the AVAILABILITY office since 2007. She leads the healthcare services placement division and brings over 30 years experience in health care placement. When Candace isn’t finding “just what the doctor ordered” she is visiting and enjoying her 5 grandchildren, gardening, wine tasting, walking, listening to music and just being with family and friends.
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Discover exciting job opportunities in the vibrant Salida, California area today! Nestled in the heart of the Golden State, Salida boasts a perfect blend of small-town charm and big-city amenities. With close proximity to the stunning Yosemite National Park and the iconic Sierra Nevada mountain range, this region offers unparalleled access to outdoor adventures and breathtaking scenery. Explore the local art scene at the Carnegie Arts Center or catch a show at the Gallo Center for the Arts. Indulge in delicious farm-to-table cuisine and sample renowned wines from nearby vineyards. Join a community that values growth and innovation, with opportunities to advance your career while enjoying a high quality of life. Browse our job listings now and make Salida your next career destination!