Enterprise Credentialing Specialist: Enterprise Credentialing

Hoag Health System; Newport Beach (CA); On-site; USD 65,000 - 90,000; Full time

Job summary

Hoag Memorial Hospital Presbyterian in Orange County, CA, is seeking a Credentialing Analyst to manage credentialing for physicians and other healthcare staff. You will support processing applications, verify information, and maintain practitioner databases to ensure accuracy and regulatory compliance.

The role involves close collaboration with clinicians and administrative teams to keep records up to date and audit-ready, upholding Hoag’s standards and values.

Qualifications

• High School diploma or equivalent required.
• Proficiency with Microsoft Office (Word, Excel, PowerPoint).
• Experience with NCQA standards preferred.
• MD Staff experience preferred.
• Proficiency with medical terminology preferred.

Responsibilities

• Maintain regulatory and accreditation compliance with relevant organizations.
• Create and carry out credentialing processes for physicians, other healthcare professionals, and sites.
• Assist in ensuring personnel and services adhere to policies, guidelines, regulations, and laws.
• Process credentialing applications and reappointment paperwork for completeness and accuracy.
• Collect and verify significant amounts of verification and accreditation data.
• Maintain databases for practitioners and facilities (education, training, licensure, experience).
• Prepare records for regular audits.
• Maintain communication with practitioners to keep records up to date.
• Demonstrate behaviours consistent with core values and required standards.

Skills

Microsoft Office

Medical terminology

NCQA standards

MD Staff experience

Education

High School diploma or equivalent

Certified Professional Credentialing Analyst (CPCS)

Certified Professional Medical Services Professional (CPMSM)

Job description

Job Description

Primary Duties And Responsibilities

• Maintain regular cooperation and compliance with all regulatory, accrediting, and membership-based organizations.
• Create and carry out credentialing processes for physicians, other healthcare professionals, and sites.
• Assist the Supervisor in ensuring that all personnel and services adhere to facility and staff policies, department guidelines, regulations, and government laws.
• Process applications and reappointment paperwork, verifying completeness and accuracy.
• Collect and process significant amounts of verification and accreditation information.
• Maintain and update accurate databases for practitioners and facilities, including education, training, experience, and licensure information.
• Prepare records for regular auditing.
• Maintain close communication with practitioners to ensure records are up to date and consistent.
• Demonstrate behaviors consistent with core values and comply with all required standards.

Qualifications

Education and Experience

• High School diploma, GED, California High Proficiency or equivalent work experience
• Proficiency with Microsoft Office Products (Word, Excel, PowerPoint)
• Experience specific to NCQA standards preferred
• MD Staff experience preferred
• Proficiency with medical terminology preferred

License Required

• N/A

License Preferred

• N/A

Certifications Required

• N/A

Certifications Preferred

• Certified Professional Credentialing Analyst (CPCS)
• Certified Professional Medical Services Professional (CPMSM)

About Us

Hoag Memorial Hospital Presbyterian is a nonprofit regional health care delivery network in Orange County, California, consisting of three acute-care hospitals with sixteen urgent care centers, eleven health centers and a network of more than1,800 physicians, 100 allied health members, 8,000 employees, and 2,000 volunteers. More than 30,000 inpatients and 550,000 outpatients choose Hoag each year.

For over 70 years, Hoag has delivered a level of personalized care that is unsurpassed among Orange County’s health care providers. Since 1952, Hoag has served the local communities and continues its mission to provide the highest quality health care services through the core strategies of quality and service, people, physician partnerships, strategic growth, financial stewardship, community benefit and philanthropy.

Hoag offers a comprehensive blend of health care services including six institutes providing specialized care in the areas of cancer, heart and vascular, neurosciences, women's health, orthopedics, and digestive health through our institutes.

Hoag was the highest ranked hospital in Orange County in the 2024-2025 U.S. News &World Report, the only Orange County hospital ranked in the top 10 for California. The organization was ranked the #5 hospital in the Los Angeles Metro Area and the #10 hospital in California.

To learn more about Hoag’s awards and accreditations, visit: https://www.hoag.org/about-hoag/awards-accreditations/ .

Hoag is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind. Hoag is committed to the principle of equal employment opportunity for all employees and providing employees with a work environment free of discrimination and harassment. Hoag hires a diverse group of people in a manner that allows them to reach their full potential in the pursuit of organizational objectives.