Credentialing Specialist

Full Circle Health Network; California (MO); Hybrid; USD 77,000 - 85,000; Full time

Job summary

Full Circle Health Network seeks a Credentialing Specialist to coordinate provider credentialing, enrollment and ongoing file maintenance in California. You will work with providers, CBOs, MCPs and regulators to ensure timely enrollment and compliance.

This is a full-time, primarily remote/office-based role requiring CA residency. The position offers a salary range of $77,000–$85,000 and contains the potential for professional growth within a supportive network.

Qualifications

• High school diploma or equivalent required.
• Associate’s degree in Healthcare Administration, Business Administration, Public Health or related field preferred.
• Minimum three (3) years of healthcare credentialing or provider enrollment experience.
• Experience with California Medi-Cal provider enrollment.
• Experience using DHCS PAVE.
• Experience working with Managed Care Organizations.
• Experience maintaining provider credentialing records.

Responsibilities

• Coordinate provider credentialing and recredentialing.
• Prepare, submit and monitor enrollment applications through DHCS PAVE and other required enrollment systems.
• Maintain complete and current credentialing files.
• Perform primary source verification of licenses, certifications, education, sanctions, exclusions, malpractice history and other requirements.
• Monitor credential expiration dates and coordinate renewals and recredentialing.
• Monitor provider enrollment and credentialing status with Medi-Cal Managed Care Plans.
• Maintain provider demographic information and organizational records.
• Coordinate provider enrollment with MCPs, IPAs and other payer organizations.
• Respond to provider credentialing and enrollment inquiries.
• Work with CBOs to obtain required documentation.
• Assist with provider onboarding and implementation.
• Participate in credentialing audits conducted by health plans, DHCS, NCQA and other regulatory agencies.
• Prepare credentialing reports and maintain audit-ready documentation.
• Collaborate with Quality, Provider Success, Operations, IT, Compliance and Executive Leadership.

Skills

Credentialing

Enrollment

Primary source verification

Regulatory compliance

Document management

Database management

Microsoft Office

Organization & Time Management

Attention to detail

Education

High school diploma

Associate’s degree in Healthcare Administration/Business/Public Health

Tools

DHCS PAVE

Credentialing databases

Microsoft Office Suite

Job description

Work Arrangement: Remote / Hybrid Work Location Requirement: Candidate must reside in California.

Travel Requirement: Occasional travel may be required for provider meetings, health plan meetings, trainings, audits, provider-site visits and other business activities.

Company Overview

FCHN is an integrated network of nonprofit, nationally accredited providers delivering coordinated community-based services to vulnerable children, individuals and families across California.

FCHN exists to ensure more Californians can access culturally congruent and trauma-informed care through a high-quality network of community-based organizations addressing whole-person and whole-family needs.

We accomplish this primarily by:

Serving as a single contracting vehicle for community-based providers to enroll in Medi-Cal managed care plan networks.

Reducing administrative burden so providers can focus on serving clients.

Improving coordination across systems through technology infrastructure, training and administrative practice support.

FCHN embraces the population health vision of CalAIM and is closely affiliated with the California Alliance of Child and Family Services.

Position Summary

The Credentialing Specialist is responsible for coordinating provider credentialing, recredentialing, enrollment, revalidation and ongoing provider file maintenance for participating healthcare providers and organizations within FCHN.

This position ensures providers meet federal, state, Medi-Cal, CalAIM, managed care and organizational credentialing requirements while maintaining accurate provider records and supporting timely network participation.

The Credentialing Specialist works collaboratively with providers, Community-Based Organizations (CBOs), Managed Care Plans (MCPs), internal departments and regulatory agencies to facilitate provider enrollment, credentialing and compliance activities.

Key Responsibilities

• Coordinate provider credentialing and recredentialing activities.
• Prepare, submit and monitor provider enrollment applications through DHCS PAVE and other required enrollment systems.
• Maintain complete and current credentialing files.
• Perform primary source verification of licenses, certifications, education, sanctions, exclusions, malpractice history and other requirements.
• Monitor credential expiration dates and coordinate renewals and recredentialing.
• Monitor provider enrollment and credentialing status with Medi-Cal Managed Care Plans.
• Maintain provider demographic information and organizational records.
• Coordinate provider enrollment with MCPs, IPAs and other payer organizations.
• Respond to provider credentialing and enrollment inquiries.
• Work with CBOs to obtain required documentation.
• Assist with provider onboarding and implementation.
• Participate in credentialing audits conducted by health plans, DHCS, NCQA and other regulatory agencies.
• Prepare credentialing reports and maintain audit-ready documentation.
• Collaborate with Quality, Provider Success, Operations, IT, Compliance and Executive Leadership.
• Maintain confidentiality.
• Perform other duties as assigned.

Essential Functions

• Independently coordinate credentialing, recredentialing and enrollment.
• Prepare, review and maintain complete, accurate, audit-ready files.
• Conduct primary source verification.
• Monitor licensure, certifications, insurance and other required documentation.
• Prepare and submit enrollment and revalidation applications through DHCS PAVE and managed care plans.
• Maintain demographic and credentialing records.
• Communicate with providers, CBOs, MCPs, regulatory agencies and internal departments.
• Research, analyze and resolve credentialing and enrollment issues.
• Assist with audits, regulatory reviews and quality assurance activities.
• Protect confidential provider, organizational and protected health information.
• Prioritize multiple assignments and deadlines while maintaining accuracy.
• Participate in meetings, training, continuous improvement initiatives and special projects.
• Perform other related duties as assigned.

Required Qualifications

• High school diploma or equivalent required.
• Associate’s degree in Healthcare Administration, Business Administration, Public Health or related field preferred.
• Minimum three (3) years of healthcare credentialing or provider enrollment experience.
• Experience with California Medi-Cal provider enrollment.
• Experience using DHCS PAVE.
• Experience working with Managed Care Organizations.
• Experience maintaining provider credentialing records.

Preferred Qualifications

• Experience supporting CalAIM provider networks.
• Experience working with Community-Based Organizations.
• Knowledge of NCQA credentialing standards.
• Experience with credentialing software and provider databases.
• Experience coordinating provider implementation.
• Experience with Community Care Hubs, ECM, Community Supports or CHW provider networks.

Knowledge, Skills & Abilities

• DHCS PAVE enrollment processes.
• Provider credentialing and recredentialing.
• Primary source verification.
• Regulatory compliance.
• Document management.
• Database management.
• Microsoft Office Suite.
• Strong organizational and time management skills.
• Provider enrollment lifecycle management and credentialing best practices.
• Ability to manage multiple deadlines with exceptional attention to detail.

Core Competencies

• Credentialing Administration: Coordinates provider credentialing, recredentialing and enrollment accurately and efficiently.
• Regulatory Compliance: Ensures compliance with DHCS, Medi-Cal, CalAIM, managed care, NCQA and organizational requirements.
• Provider Enrollment & Credentialing: Facilitates timely provider enrollment and participation.
• Attention to Detail: Maintains complete, accurate and audit-ready documentation.
• Communication: Communicates effectively with providers, health plans and cross-functional teams.
• Organization & Time Management: Manages multiple credentialing cycles, deadlines and priorities.
• Problem Solving: Researches credentialing issues and develops timely solutions.
• Collaboration: Builds productive relationships.
• Accountability: Demonstrates ownership while maintaining quality and compliance.
• Continuous Improvement: Identifies opportunities to improve credentialing workflows, documentation and operational efficiency.

Expected Hours

This is a full-time, non-exempt position regularly scheduled to work 40 hours per workweek Monday through Friday during established business hours.

Employees must accurately record all hours worked and take required meal and rest periods. Overtime and work outside the established schedule require advance approval. All time worked must be reported and will be compensated. Off-the-clock work is prohibited.

Supervisory Responsibilities

This position does not have direct supervisory responsibilities.

This position is primarily remote and office-based. The role includes credentialing administration, provider enrollment, regulatory compliance, documentation management, data entry, audit preparation and communication requiring regular use of DHCS PAVE, credentialing databases, Microsoft Office, virtual meeting platforms and organizational systems.

Work Location & Home Office Requirement

The employee must reside in California and maintain a safe, professional, secure and suitable home office that protects sensitive provider and organizational information.

Physical Demands

This position requires extended periods of sitting, computer use, detailed document review, telephone and video communication and occasional travel. The position may occasionally require lifting or moving materials up to 15 pounds.

Compensation

Salary Range: $77,000–$85,000

Final compensation will be determined based on experience, qualifications, internal equity and organizational budget considerations.

Why Join FCHN?

You will play an important role in helping community-based providers successfully participate in California's evolving Medi-Cal delivery system while supporting accurate, compliant and efficient network growth.

Equal Employment Opportunity / Reasonable Accommodation / Background Checks

FCHN is an Equal Opportunity Employer committed to maintaining a diverse, inclusive and respectful workplace. Reasonable accommodations are available in accordance with applicable law. Employment offers may be contingent upon lawful job-related reference and background screening requirements. Any criminal history inquiry will be conducted in accordance with the California Fair Chance Act and applicable law.