Credentialing Specialist
Location: beverly hills, CA
Job Type: Contract
Company: IDR
Category: Administrative / Clerical
Job Description Apply Now
The Credentialing Specialist plays a critical role in healthcare organizations by ensuring the integrity, compliance, and accuracy of provider credentialing processes. As a Credentialing Specialist, you will be responsible for reviewing and maintaining provider information and documentation to support managed care business operations. This position is essential to maintaining compliance within healthcare networks and ensuring that provider records are always current, accurate, and in line with regulatory requirements.
Credentialing Specialists are vital in supporting managed care operations, including provider networks, HMO referrals, claims, and contracts. Working closely with internal teams and third-party organizations, you will ensure that provider contract records are maintained accurately and that all changes are communicated efficiently. This includes updating provider contract grids, resolving discrepancies within electronic records systems such as Epic Tapestry, and conducting regular audits to guarantee compliance with state and federal legislation, such as Senate bill AB137. The role requires a keen attention to detail and the ability to manage multiple priorities while upholding the highest standards of data integrity and confidentiality.
In this role, you will regularly collaborate with the Contracting team to assess and address the financial implications of contract discrepancies and participate in the implementation of new or amended provider contracts. Your responsibilities will also involve supporting the accuracy of provider paneling information for Health Plans and ensuring timely updates are provided to all necessary parties. Proficiency in Excel, a strong understanding of HMO and Fee-for-Service business lines, and familiarity with credentialing software such as Epic Tapestry will help you succeed in this position. The ideal candidate will also demonstrate a solid grasp of physician insurance compliance and data management practices.
As a Credentialing Specialist, you will be an integral part of a collaborative, team-oriented environment within a reputable, industry-leading company. Joining this organization offers you the opportunity to grow professionally and contribute to a dynamic healthcare network. The company fosters a supportive workplace culture, with a focus on compliance, operational excellence, and continuous improvement. Employees benefit from competitive compensation, comprehensive benefits packages, and access to ongoing career development opportunities.
Working in this area provides access to a thriving healthcare industry, with opportunities to network with top professionals and make a meaningful impact on patient care quality and provider relations. The company values diversity and inclusivity, ensuring that all qualified applicants are considered for employment. If you are detail-oriented, committed to compliance, and eager to be part of a collaborative healthcare team, we encourage you to click the job application button and take the next step in your credentialing career.
Credentialing Specialist - Summary- Responsible for ensuring the integrity, compliance, and accuracy of provider credentialing processes within a healthcare network
- Works closely with managed care operations, provider networks, and internal teams to maintain up-to-date credentialing records
- Acts as the primary point of contact for resolving discrepancies and supporting contract management
- Review Provider Information Forms (PIFs) to support managed care business needs, including provider networks, HMO referrals, claims, and contracts
- Maintain and update downstream provider contract grids and communicate changes to third-party MSOs
- Assist in resolving discrepancies in provider contract records within Epic Tapestry and HMO referral systems
- Conduct regular audits of provider updates to ensure accuracy and compliance with applicable legislation (e.g., Senate bill AB137)
- Collaborate with Contracting teams to assess financial implications of discrepancies and support the implementation of new or amended contracts
- Ensure the accuracy of paneling information provided to Health Plans
- Competitive compensation package
- Comprehensive benefits including Medical, Vision, Dental, and more
- Opportunities for career growth and advancement within the organization
- Employee Stock Ownership Program
- Recognition as a Best of Staffing® Client and Talent Award winner
- High School Diploma or GED required; Bachelor’s Degree preferred
- Experience with physician insurance compliance and maintaining data integrity
- Proficiency in Excel and understanding of HMO and Fee-for-Service business lines
- Familiarity with Epic Tapestry preferred
- Flu vaccination required (no declinations or exemptions)
- Detail-oriented and able to manage multiple priorities efficiently
- Strong collaborator with excellent communication skills
- Experienced in healthcare credentialing processes and compliance standards
- Proactive in resolving discrepancies and ensuring data accuracy
- Work as part of a close-knit, team-oriented culture with a focus on operational excellence and continuous improvement
- Opportunities to engage with a leading healthcare organization and contribute to industry best practices
- Career advancement supported by a reputable company with over 25 years of proven industry experience
- All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. IDR is subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, we invite employees to voluntarily self-identify their race or ethnicity, gender, and veteran status (if applicable). Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information obtained will be kept confidential and may only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement. You may access this form here.
If you are ready to take the next step in your healthcare credentialing career, apply today by clicking the job application button and join a team that values your expertise and dedication to compliance and operational excellence.