Credentialing Specialist

Inspire Health Medical Group; Fresno (CA); On-site; USD 52,000 - 70,000; Full time

Job summary

Inspire Health Medical Group in Fresno, CA seeks a credentialing specialist responsible for processing provider credentialing, enrollment, and re-credentialing for facilities and health plans. You will support onboarding and compliance by coordinating with internal teams and external payers to meet requirements efficiently.

We value accuracy, timely communication, and process improvements as you manage payer enrollment, keep records updated, and help ensure physicians and staff maintain active

Qualifications

• High School Diploma or equivalent; Associate’s degree preferred.
• Minimum two (2) years of credentialing experience in a medical setting.

Responsibilities

• Initiate and support credentialing applications by collecting provider documents.
• Collaborate with recruitment and medical staff offices for onboarding.
• Follow-up with practitioners and entities to resolve credentialing discrepancies.
• Manage all phases of payer credentialing/enrollment and re-credentialing.

Skills

Credentialing

Medical Administration

Data Entry

Education

High School Diploma

Associate’s degree (preferred)

Job description

A non-exempt position responsible for the accurate and timely processing of provider credentialing, enrollment, and re-credentialing for medical facilities and health plans. This role supports provider onboarding and ongoing compliance by coordinating with internal departments, practitioners, medical staff offices, and external payer entities to ensure credentialing requirements are met efficiently and in accordance with organizational policies.

JOB FUNCTIONS:

• Initiate and support the credentialing application process by requesting, receiving and analyzing the provider’s documents for submission to the facilities for approval for medical staff privileges and payer credentialing/enrollment
• Collectively works with recruitment for onboarding practitioners and medical staff office team to assure practitioner’s credentialing process is efficient and timely
• Use critical thinking to conduct follow-up with individual practitioners, internal and external entities to resolve discrepancies identified during credentialing and enrollment process that may inhibit timely onboarding
• Manage all phases of payer credentialing/enrollment, re-credentialing/re-enrollment, notification of changes including termination of group practitioners
• Complete regular follow-up with the payers to ensure credentialing and enrollment is complete and escalated communication with payer provider enrollment staff of any issues prohibiting timely credentialing/enrollment
• Keep Physician Services Manager and supporting departments informed of potential credentialing and enrollment issues
• Update and maintain provider credentialing information database and electronic data files in accordance with internal policies and procedures while also maintaining confidentiality of provider information
• Actively participate in team meetings and process improvement initiatives to continuously improve work product and efficiency
• Develop, document, and maintain accurate work instructions for the desk, ensuring all procedures and information remain current
• Promote the purpose, values and foundations of Inspire Health Medical Group at all levels of the organization and to our customers
• Perform other related duties as assigned to support Physician Services operations

Requirements

• High School Diploma or equivalent; Associate’s degree preferred
• Minimum two (2) years of credentialing experience in a medical setting