Credentialing Specialist

Overview

Monday through Friday, from 8am to 430pm Compensation We Offer The initial compensation for this position ranges from $23 to $28.23 Per Hour, depending on experience, location and internal equity considerations Possible Additional Compensation (may vary based on position eligibility) Possible Bilingual Differentials: Up to 7.

5% for qualifying direct-service roles; up to $80.00/month flat fee for qualifying non-direct service roles.

Benefits

We Offer Benefits Eligibility starts on day ONE We provide a robust benefits package which includes medical, dental, vision, See our Benefits Page HERE. 401K Employer Match up to 4% Competitive Time Off Plans Must meet eligibility requirements based on employment status Pay Range $23 - $28.23 Job Summary The Credentialing Specialist is responsible for ensuring that all healthcare professionals within the organization are properly credentialed and compliant with state, federal, and organizational regulations.

This role involves verifying the qualifications of the workforce members, maintaining accurate and up-todate records, and ensuring timely re-credentialing. The Credentialing Specialist plays a crucial role in supporting the overall quality of care provided by the organization.

Responsibilities

Conducts primary source verifications of licensure, board certifications, education, and work history. Tracks and manages re-credentialing timelines to ensure timely renewal and compliance. Maintains and updates credentialing databases and records with accuracy and confidentiality. Communicates with providers and internal departments regarding credentialing status and documentation needs.

Collaborates with compliance and quality teams to ensure adherence to standards (e.g., NCQA, CMS, The Joint Commission). Responds to credentialing-related inquiries and audit requests. Assists in preparing files for credentialing committee review and maintain records of decisions.

Qualifications

Associate degree (AA/AS) in healthcare administration, business, or a related field and (2) two or more years of relevant experience required; or equivalent combination of education and experience to include: Minimum of (2) 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 1–2 years if not already help Job Competencies Demonstrates strong attention to detail and accuracy Maintains confidentiality and exercises discretion with sensitive information Manages time effectively and meets strict deadlines Communicates clearly, professionally, and respectfully Applies sound judgment when resolving issues or discrepancies Works independently while also contributing to team goals Adapts to changing priorities and processes with flexibility Maintains a high level of reliability and accountability Builds positive relationships with internal staff and external providers Physical Requirements The work environment conditions as described below are representative of those that must be met by an employee to successfully perform the essential functions of this job.

Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee may be required to use hands to handle or feel objects, tools or controls; reach with hands and arms; and taste or smell. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

N/A Will not have unsupervised contact with children. Requires full background check and TB Exam. We are an Equal Opportunity Employer, which includes providing reasonable accommodations for individuals with a disability. We will consider for employment, qualified Applicants with Criminal Histories in a manner consistent with ordinance 184652 Sec.

189.04 (a) and San Francisco Police Code, Article 49. Section 4905. Conducts primary source verifications of licensure, board certifications, education, and work history. Tracks and manages re-credentialing timelines to ensure timely renewal and compliance. Maintains and updates credentialing databases and records with accuracy and confidentiality. Communicates with providers and internal departments regarding credentialing status and documentation needs. Collaborates with compliance and quality teams to ensure adherence to standards (e.g., NCQA, CMS, The Joint Commission). Responds to credentialing-related inquiries and audit requests. Assists in preparing files for credentialing committee review and maintain records of decisions. Associate degree (AA/AS) in healthcare administration, business, or a related field and (2) two or more years of relevant experience required; or equivalent combination of education and experience to include: Minimum of (2) 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 1–2 years if not already help