Credentialing Specialist: CAQH & Compliance Expert

Imperial Health Plan of California, Inc.; Pasadena (CA); On-site; USD 52,000 - 70,000; Full time

Job summary

Imperial Health Plan of California, Inc. is seeking a Credentialing Specialist to handle high volumes of initial provider applications in compliance with CMS and NCQA standards.

You will verify information, manage CAQH and tracking databases, and liaise with providers and health plans to ensure timely credentialing and re-appointments.

Strong knowledge of credentialing terminology and documentation, plus proficiency in MS Office and electronic systems, is essential.

Qualifications

• High school graduate with credentialing experience preferred.
• Proficient with CAQH and Primary Source Verification processes.
• Experience maintaining provider data accuracy and regulatory compliance.

Responsibilities

• Process high volume of initial provider applications per policy.
• Verify information using primary sources and document adverse actions.
• Review applications for Credentialing Committee approval.
• Maintain provider files with current licenses and certifications.
• Coordinate with staff to obtain necessary information for IPA's.
• Manage CAQH and credentialing tracking databases.
• Prepare credentialing documentation for committees and risk management.

Skills

MS Office

Excel

Adobe Acrobat

English communication

Time management

Prioritization

HIPAA compliance

Education

High school diploma or equivalent

Tools

CAQH

ICE Checklist

Primary Source Verification systems

Job description

Imperial Health Plan of California, Inc. is seeking a Credentialing Specialist to handle high volumes of initial provider applications in compliance with CMS and NCQA standards.

You will verify information, manage CAQH and tracking databases, and liaise with providers and health plans to ensure timely credentialing and re-appointments.

Strong knowledge of credentialing terminology and documentation, plus proficiency in MS Office and electronic systems, is essential.