Credentialing Specialist

Advance CVO, LLC; California (MO); On-site; USD 55,000 - 75,000; Full time

Job summary

Advance CVO, LLC is seeking an on-site Credentialing Specialist based in Orange County, CA. You will manage provider credentialing files, verify qualifications, and ensure accurate completion of applications for government and commercial payers, while maintaining CAQH records.

Daily duties include collecting documentation, tracking expirables, assisting with re-credentialing, and keeping records up to date in internal systems.

Qualifications

• Strong medical staff credentialing skills and payer enrollment experience.
• Knowledge of Medicare and other government or commercial plan requirements.
• Excellent communication and customer service with providers, payers, and staff.
• High attention to detail, organization, and ability to manage multiple files.

Responsibilities

• Manage provider credentialing files and verify qualifications.
• Prepare and submit applications for government and commercial payers.
• Maintain CAQH portal and track expirables and re-credentialing.
• Communicate with providers, payers, and internal teams to resolve discrepancies.

Skills

Credentialing

Payer enrollment

CAQH

Attention to detail

Communication

Team collaboration

Tools

Credentialing software

MS Office

Job description

Company Description Advance CVO, LLC provides clients with credentialing and payer enrollment services.

Managing end-to-end credentialing, from PSV, initial enrollment, expirables management, re-credentialing & contracting solutions. The organization supports all payers, government, and commercial health plans, managing CAQH helping healthcare providers remain compliant and properly enrolled. By handling complex credentialing processes, Advance CVO, LLC allows clients to focus on delivering care and serving their own customers. Team members work in a detail-oriented environment that values accuracy, efficiency, and professional service.

Role Description This contract, on-site Credentialing Specialist role is based in Orange County, CA. The Credentialing Specialist will manage provider credentialing files, verify qualifications, and ensure accurate completion of applications for government, and commercial payers and manage CAQH portal. Daily tasks include collecting and reviewing documentation, tracking expirables, assisting with re-credentialing processes, and maintaining up-to-date records in internal systems. The role also involves communicating with providers, payers, and internal teams to resolve discrepancies and respond to credentialing inquiries. The specialist will follow established procedures, meet deadlines, and support compliance with regulatory and payer requirements.

Qualifications

• Strong medical staff credentialing skills, including experience with payer enrollment and re-credentialing processes.
• Knowledge of Medicare and other government or commercial insurance plan requirements.
• Effective communication and customer service skills for interacting with providers, payers, and Administrators.
• High level of attention to detail, organizational skills, and ability to manage multiple files and deadlines.
• Proficiency with credentialing software, databases, and standard office tools (e.g., spreadsheets, document management).
• Experience in healthcare administration, medical billing, or provider enrollment is beneficial.
• Ability to work on-site in Orange County, CA and collaborate in a team-oriented environment.
• Relevant certification in medical staff services or credentialing (e.g., CPCS or CPMSM) preferred but not required.