Credentialing Coordinator Medicare HMO

Ultimate Staffing; Long Beach (CA); On-site; USD 55,000 - 75,000; Full time

Job summary

Ultimate Staffing is seeking a Credentialing Coordinator/Analyst (Temp) to support the Credentialing Department in processing provider credentialing and recredentialing activities. The role includes PSV coordination, provider onboarding, data analysis, and audit/compliance readiness to ensure timely activation and roster accuracy.

The temporary position is aimed at increasing processing capacity during high-volume onboarding, acquisitions, or audit preparation cycles, with responsibility

Responsibilities

• Credentialing File Preparation and Processing Support: Assist in preparing credentialing and recredentialing files with provider documentation.
• Primary Source Verification (PSV) Coordination: Coordinate PSV activities including licensure, board certification, education verification, and sanctions according to policy.
• Provider Onboarding Support: Assist credentialing specialists and provider network teams in processing onboarding credentialing packets.
• Credentialing Data Analysis and Reporting: Support operational reporting such as file completeness, recredentialing expiration, and cycle time tracking.
• Delegation Audit and Compliance Preparation Support: Help organize credentialing files for audit readiness and compliance reviews.
• Roster and Provider Data Support: Validate provider demographic and affiliation data and coordinate with teams for data updates.
• Administrative and Operational Support: Backlog reduction initiatives and system updates during high-volume periods.

Skills

Credentialing coordination

Data entry

Audit readiness

Organization

Tools

Credentialing software

MS Office

Job description

The Credentialing Coordinator / Analyst (Temp) supports the Credentialing Department in processing provider credentialing and recredentialing activities, performing credentialing file preparation, primary source verification (PSV) coordination, provider onboarding support, and credentialing data analysis tasks.

This temporary role is designed to increase credentialing processing capacity to ensure timely provider activation, roster accuracy, and compliance with NCQA, CMS, State, and Health Plan delegated credentialing requirements, particularly during high-volume onboarding initiatives, acquisitions, expansions, or audit preparation cycles.

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Key Responsibilities

1. Credentialing File Preparation and Processing Support
   • Assist in preparing credentialing and recredentialing files for processing by collecting and organizing required provider documentation.
   • Review credentialing applications for completeness and follow up with providers or practices to obtain missing documentation.
   • Support data entry and updates within credentialing systems to ensure accurate provider records.
2. Primary Source Verification (PSV) Coordination
   • Conduct or support primary source verification activities including licensure, DEA, board certification, education, sanctions, and malpractice verification according to established policies.
   • Ensure PSV documentation is properly stored and indexed within credentialing systems for audit readiness.
3. Provider Onboarding Support
   • Assist credentialing specialists and provider network teams in processing onboarding provider credentialing packets.
   • Track onboarding documentation receipt and follow up on outstanding credentialing requirements.
   • Help ensure credentialing files are prepared for timely submission and committee review where applicable.
4. Credentialing Data Analysis and Reporting
   • Support credentialing operational reporting including:
     • File completeness tracking
     • Recredentialing expiration tracking
     • Credentialing cycle time monitoring
     • Credentialing backlog monitoring
   • Assist in maintaining credentialing tracking logs and reporting dashboards.
5. Delegation Audit and Compliance Preparation Support
   • Assist in organizing credentialing files to ensure audit readiness for internal compliance reviews, health plan delegation audits, and NCQA surveys.
   • Support credentialing file quality reviews and corrective documentation completion where required.
6. Roster and Provider Data Support
   • Assist with validation of provider demographic information and affiliation data supporting roster submissions.
   • Coordinate with credentialing specialists to ensure provider data updates are processed accurately.
7. Administrative and Operational Support
   • Support credentialing team backlog reduction initiatives and special credentialing projects.
   • Perform credentialing document scanning, indexing, file preparation, and system updates as needed.
   • Provide general operational support to credentialing supervisors and managers during high-volume periods.

All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the California Fair Chance Act, City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, Los Angeles County Fair Chance Ordinance, and San Francisco Fair Chance Ordinance.