Credentialing Specialist

Ultimate Staffing Services; Livingston (CA); On-site; USD 33,000 - 36,000; Full time

Job summary

Ultimate Staffing Services seeks a Credentialing Specialist in Livingston, CA to manage the full credentialing lifecycle for licensed providers, coordinate privileging, and ensure timely payor enrollment. The role emphasizes accuracy, regulatory compliance, and collaboration with billing teams.

Responsibilities include maintaining provider files, completing licensing steps, and preparing reports for leadership while supporting onboarding and recredentialing processes in a healthcare setting.

Qualifications

• Experience in a related role is preferred, but not required.
• Strong organizational and communication skills.
• Attention to detail and ability to manage multiple tasks efficiently.

Responsibilities

• Manage the full credentialing lifecycle for licensed providers and other credentialed staff, including initial credentialing, primary source verification, and recredentialing every two years.
• Coordinate the privileging process, ensuring all privilege requests are complete, reviewed, and approved by the Board of Directors.
• Maintain accurate and complete provider files, credentialing database, and credentialing software systems.
• Track and verify license, DEA, BLS, malpractice insurance, board certifications, NPDB, and other required documents for ongoing compliance.
• Coordinate and track annual peer review results and ensure the CMO reviews and incorporates them into recredentialing and reprivileging.
• Prepare reports for the Quality Committee, MEC, and Board regarding credentialing and privileging status.
• Manage enrollment and re-enrollment with Medicaid, Medicare, and commercial insurers.
• Prepare, submit, and track enrollment applications including provider adds, terminations, updates, and reassignment of benefits.
• Maintain accurate payor rosters and CAQH profiles for all providers.
• Monitor effective dates and ensure billing and reimbursement are not delayed.
• Collaborate with billing and revenue cycle teams to resolve enrollment-related claim denials.

Skills

Attention to detail

Organizational skills

Communication skills

Job description

Credentialing Specialist (JN -072026-425339) Livingston, California

Salary: USD24 - USD26 per hour

Ultimate Staffing Services is actively seeking a dedicated Credentialing Specialist to join a dynamic team in California. This role requires someone who is detail-oriented and has a passion for ensuring compliance and maintaining high standards within the healthcare sector. The ideal candidate will be responsible for the full credentialing lifecycle and manage payor enrollment, facility licensing, and more. This position is integral to maintaining compliance with regulatory bodies and ensuring a seamless onboarding experience for providers.

Responsibilities

General Compliance

Ensures the organization maintains compliance with HRSA, FTCA, CMS, NCQA, and other applicable regulatory and accrediting bodies, facilitating timely provider onboarding and payor enrollment. Responsible for facility, site, and service-line licensing, ensuring timely renewals, accurate postings, and alignment with payer/site enrollments.

• Manage the full credentialing lifecycle for licensed providers and other credentialed staff, including initial credentialing, primary source verification, and recredentialing every two years.
• Coordinate the privileging process, ensuring all privilege requests are complete, appropriately reviewed, and approved by the Board of Directors.
• Maintain accurate and complete provider files, credentialing database, and credentialing software systems.
• Track and verify license, DEA, BLS, malpractice insurance, board certifications, NPDB, and other required documents to ensure ongoing compliance.
• Coordinate and track annual peer review results and ensure the Chief Medical Officer (CMO) reviews and incorporates them into the recredentialing and reprivileging process.
• Prepare reports for the Quality Committee, Medical Executive Committee, and Board of Directors regarding credentialing and privileging status.
• Manage enrollment and re-enrollment with all contracted health plans (Medicaid, Medicare, and commercial insurers).
• Prepare, submit, and track all enrollment applications, including provider adds, terminations, demographic updates, and reassignment of benefits.
• Maintain accurate payor rosters and CAQH profiles for all providers.
• Monitor effective dates and ensure billing and reimbursement are not delayed.
• Collaborate with the billing and revenue cycle teams to resolve enrollment-related claim denials.

Facility Licensing

• Maintain a comprehensive inventory of all organizational facility, site, and service-line licenses/permits/registrations, including license numbers, effective/expiration dates, scope of services, locations, and required postings.
• Prepare, submit, and track initial applications and renewals for facility and service-line licenses (e.g., clinic license, CLIA, radiology, lab, DME, pharmacy, and local business licenses), preventing lapses and interruptions in operations.
• Manage Medicare/Medicaid revalidations and state enrollment renewals for facilities.
• Maintain a centralized, audit-ready license repository and ensure current postings at each site; respond to payer, regulator, or accreditor requests within stated timelines.

Requirements

• Experience in a related role is preferred, but not required.
• Strong organizational and communication skills.
• Attention to detail and ability to manage multiple tasks efficiently.

Work Hours

1st Shift: Monday to Friday

Competitive pay, ranging from $24 to $26 per hour, depending on experience.