Credentialing Specialist I - Healthcare Data & Compliance

Partnership HealthPlan of California; Fairfield (CA); On-site; USD 46,000 - 56,000; Full time

Job summary

Partnership HealthPlan of California is seeking a Credentialing Specialist to gather and validate practitioner credentialing information and respond to inquiries by phone and email. The role involves credentialing, tracking forms, researching discrepancies, and maintaining accurate files to support compliance with regulatory standards.

Responsibilities include preparing reports in Word/Excel, data entry into databases, and educating providers on submission requirements.

Qualifications

• High school diploma or equivalent; one year credentialing or healthcare experience preferred.
• Strong written and oral communication skills.
• Advanced computer skills including Microsoft Office; ability to handle sensitive issues with diplomacy and tact.

Responsibilities

• Performs credentialing and re-credentialing activities.
• Sends forms and related documentation and tracks timely return of information.
• Gathers information and researches discrepancies; ensures accuracy.
• Monitors licensing boards and reporting sites.
• Reviews documents and writes concise summaries.
• Prepares and maintains files to demonstrate compliance.
• Educates providers on form completion and submissions.
• Prepares reports and templates using Word and Excel.
• Enters data into multiple databases.
• Responds to telephone inquiries.
• Other duties as assigned.

Skills

Communication skills

Multitasking

Interpersonal skills

Detail oriented

Diplomacy and tact

Education

High school diploma or equivalent

Tools

Microsoft Word

Microsoft Excel

Job description

Partnership HealthPlan of California is seeking a Credentialing Specialist to gather and validate practitioner credentialing information and respond to inquiries by phone and email. The role involves credentialing, tracking forms, researching discrepancies, and maintaining accurate files to support compliance with regulatory standards.

Responsibilities include preparing reports in Word/Excel, data entry into databases, and educating providers on submission requirements.