Credentialing Specialist: Compliance & Records Expert

Pacific Clinics; Arcadia (CA); On-site; USD 32,000 - 39,000; Full time

Benefits offered by this job

Health benefits

401K with employer match

Day-one eligibility for benefits

Paid time off

Job summary

Pacific Clinics is seeking a Credentialing Specialist to verify licensure, certifications, and education for our healthcare professionals. You will manage credentialing timelines, maintain confidential records, and coordinate with compliance and quality teams to meet NCQA and CMS standards.

The role requires knowledge of credentialing databases (CAQH/Verity/MD-Staff) and proficiency in MS Office. A background in healthcare administration and 2+ years of credentialing experience are expected.

Qualifications

• AA/AS in healthcare administration or related field; two years credentialing experience or equivalent.
• Knowledge of NCQA, CMS, and The Joint Commission credentialing standards.
• Experience with credentialing databases (CAQH, Verity, MD-Staff) and MS Office.

Responsibilities

• Conducts primary source verifications of licensure, board certifications, education, and work history.
• Tracks and manages re-credentialing timelines to ensure timely renewal and compliance.
• Maintains and updates credentialing databases and records with accuracy and confidentiality.
• Communicates with providers and internal departments regarding credentialing status and documentation needs.
• Collaborates with compliance and quality teams to ensure adherence to standards (NCQA, CMS, Joint Commission).
• Responds to credentialing inquiries and audit requests.
• Prepares files for credentialing committee review and maintains records of decisions.

Skills

Attention to detail

Discretion with confidential data

Time management

Clear communication

Education

AA/AS in healthcare administration or related field

Two years credentialing experience

Tools

CAQH

Verity

MD-Staff

Excel

Outlook

Word

Job description

Pacific Clinics is seeking a Credentialing Specialist to verify licensure, certifications, and education for our healthcare professionals. You will manage credentialing timelines, maintain confidential records, and coordinate with compliance and quality teams to meet NCQA and CMS standards.

The role requires knowledge of credentialing databases (CAQH/Verity/MD-Staff) and proficiency in MS Office. A background in healthcare administration and 2+ years of credentialing experience are expected.