Credentialing Specialist

Pacific Clinics; Arcadia (CA); On-site; USD 32,000 - 39,000; Full time

Benefits offered by this job

Medical, dental, vision

Day-one benefits eligibility

401K match 4%

Paid time off

Job summary

Pacific Clinics is seeking a Credentialing Specialist to ensure all healthcare professionals are properly credentialed and compliant with state, federal, and organizational standards. You will verify qualifications, maintain accurate records, and support timely re-credentialing to sustain high care quality.

The role requires performing primary source verifications, tracking renewals, maintaining databases, and coordinating with compliance and quality teams to meet NCQA/CMS/JCAHO standards, while

Qualifications

• AA/AS in healthcare administration or related field plus 2+ years credentialing experience.
• Experience with NCQA, CMS and The Joint Commission requirements.
• Proficiency with credentialing databases such as CAQH, Verity or MD-Staff; MS Office.

Responsibilities

• Performs primary source verifications of licensure, board certifications, education and work history.
• Tracks and manages re-credentialing timelines for timely renewals.
• Maintains credentialing databases with accuracy and confidentiality.
• Communicates credentialing status and needs with providers and internal departments.
• Collaborates with compliance and quality teams to meet standards (NCQA, CMS, JCAHO).
• Prepares files for credentialing committee review and records decisions.

Skills

Credentialing

Regulatory knowledge

MS Office

Communication

Confidentiality

CMS compliance

NCQA

CAQH

Education

AA/AS in healthcare administration

Tools

CAQH

Verity

MD-Staff

Excel

Outlook

Word

Job description

Overview

Schedule: 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

• BenefitsEligibilitystarts on day ONE

• We provide a robust benefits package which includes medical, dental, vision,See our Benefits Page HERE.

• 401K Employer Match up to4%

• 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.