Healthcare Credentialing Specialist

MemorialCare Health System; Colonia Juarez (CA); On-site; USD 40,000 - 55,000; Full time

Job summary

MemorialCare Health System is seeking a Credentialing Clerk to support Physician Billing Services. The role involves obtaining and renewing physician credentials, maintaining CAQH profiles, tracking renewals, and coordinating with payers and departments to ensure timely provider enrollment.

Responsibilities include submitting applications for Aetna, BCBS, Medicare, and Medicaid, monitoring expirations, and ensuring compliant documentation is securely stored.

Qualifications

• Six months to one year of general medical front office experience.
• Experience with HIPAA privacy requirements is a plus.
• An associate degree may substitute for direct medical office experience.
• CPCS certification is preferred but not required for entry-level.
• High school diploma or GED required.

Responsibilities

• Obtain and maintain physician data to produce CPPA/CAQH applications.
• Prepare and submit payer enrollment packets for new credentials or recredentialing.
• Maintain and update CAQH profiles and provider files securely.
• Verify licenses, certifications, and education with primary sources.
• Monitor license renewals and manage credentialing timelines.
• Communicate approvals to relevant departments and payer contacts.
• Support readiness for audits and coordinate with hospital staff.

Skills

Customer service

Professional communication

Data entry

Education

High school diploma or GED

Associate degree in Healthcare Administration or Business may substitute for direct medical office experience

CPCS certification preferred

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Job description

MemorialCare Health System is seeking a Credentialing Clerk to support Physician Billing Services. The role involves obtaining and renewing physician credentials, maintaining CAQH profiles, tracking renewals, and coordinating with payers and departments to ensure timely provider enrollment.

Responsibilities include submitting applications for Aetna, BCBS, Medicare, and Medicaid, monitoring expirations, and ensuring compliant documentation is securely stored.