Managed Care Credentialing Specialist

Northeast Community Clinic; Alhambra (CA); On-site; USD 42,000 - 64,000; Full time

Job summary

Northeast Community Clinic is seeking a Credentialing Coordinator to manage and update files for credentialing applications and re-credentialing processes. You will coordinate with medical staff, licensing agencies, and insurance carriers to ensure QA compliance.

The role supports provider credentials, maintains license/DEA/NPI records, and handles IPAs communications while adhering to privacy and deadline requirements; occasional travel is required.

Qualifications

• AA Degree or higher required; experience may substitute for education.
• 1-2 years of healthcare administrative support experience.
• Familiar with Managed Care Programs and Credentialing processes.
• Strong communication and teamwork, bilingual preferred.

Responsibilities

• Facilitate initial credentialing, ongoing monitoring and re-credentialing.
• Maintain and update provider credentialing database with licenses, DEA, NPI, diplomas.
• Coordinate with IPAs, clinics, and insurance to ensure QA compliance.
• Prepare and submit verification letters and forms to health plans.
• Provide status reports and serve as point of contact for IPAs.

Skills

Excellent Communication Skills

Excellent Customer Service Skills

Bi-lingual Spanish/English

Team player

Independent worker

Reliable transportation

Travel ability 10% outside local area

Education

AA Degree or higher

Tools

Microsoft Office

Word

Excel

Outlook

Job description

Northeast Community Clinic is seeking a Credentialing Coordinator to manage and update files for credentialing applications and re-credentialing processes. You will coordinate with medical staff, licensing agencies, and insurance carriers to ensure QA compliance.

The role supports provider credentials, maintains license/DEA/NPI records, and handles IPAs communications while adhering to privacy and deadline requirements; occasional travel is required.