Credentialing Operations Specialist

Veterans in Healthcare; Los Angeles (CA); On-site; USD 41,000 - 65,000; Full time

Job summary

Keck Hospital of USC in Los Angeles, CA is seeking a Credentialing Coordinator to ensure practitioner credentialing aligns with internal policies and regulatory standards. You will audit files, maintain records, and manage provider data with integrity, supporting audits and site visits.

The role involves processing initial and reappointment applications, tracking timelines, and coordinating with departments to ensure credentials are prepared for committees and delivery to clients.

Qualifications

• High school diploma or equivalent required.
• Bachelor's degree in a related field preferred.
• 5 years’ experience in credentialing preferred.
• Experience in medical group credentialing/enrollment preferred.
• Hospital or multi-entity credentialing experience preferred.
• Knowledge of Joint Commission, DNV, NCQA, CMS regulations preferred.
• CPMSM or CPCS certification preferred.

Responsibilities

• Process initial credentialing and reappointment applications and review for completeness, per policies.
• Review all materials for completeness and maintain dialogue to ensure credentialing by start/reappointment date.
• Follow up with Medical Staff Offices and other stakeholders on incomplete information.
• Maintain paper/electronic credentials files and practitioner databases; ensure data accuracy and timeliness.
• Perform electronic and written queries to agencies for licensure, malpractice, and certifications; assess responses for follow-up.
• Process reappointment/credentialing applications with OPPE data and submit for committee review.
• Monitor receipt of credentialing information and ensure timely second/third requests.
• Evaluate completeness of applicant files for chair/designee and committee review.
• Work with supervisor on reappointment names/dates.
• Decide if information meets regulatory and bylaws requirements; protect data confidentiality.
• Manage expiring documents process and notify relevant parties.
• Coordinate site visits, licensing/accreditation surveys, and audits.
• Assist with internal/external audits and prepare practitioner credentials for clients.
• Flag credentialing issues and escalate to supervisor as needed.

Education

High school diploma or equivalent

Bachelor's degree in related field

Job description

Keck Hospital of USC in Los Angeles, CA is seeking a Credentialing Coordinator to ensure practitioner credentialing aligns with internal policies and regulatory standards. You will audit files, maintain records, and manage provider data with integrity, supporting audits and site visits.

The role involves processing initial and reappointment applications, tracking timelines, and coordinating with departments to ensure credentials are prepared for committees and delivery to clients.