Physician Credentialing & Compliance Specialist

Retina-Vitreous Associates Medical Group; California; On-site; USD 42,000 - 64,000; Full time

Job summary

Retina-Vitreous Associates Medical Group in California is seeking a credentialing specialist to manage applications, verifications, and compliance for physicians. You will ensure licensing, certifications, and malpractice coverage are current, and serve as a liaison among providers, practice management, insurers, and regulators.

Responsibilities include primary source verification, payer enrollment with Medicare/Medicaid, maintaining CAQH and other databases, auditing files, and preparing

Responsibilities

• Application Management: Prepare, collect, and submit credentialing and re-credentialing applications for physicians/
• Verification: Conduct primary source verification of education, training, board certifications, work history, and professional references.
• Compliance & Standards: Ensure adherence to federal, state, and payer regulations.
• Payer Enrollment: Submit and follow up on provider enrollment with Medicare, Medicaid, and commercial insurance networks.
• Database & Records Management: Maintain credentialing databases (e.g., CAQH, Echo, MD-Staff).
• Communication & Coordination: Serve as a liaison between providers, practice management, insurance companies, and regulatory bodies.
• Auditing & Quality Assurance: Conduct internal audits to ensure credentialing files are complete and accurate.

Job description

Retina-Vitreous Associates Medical Group in California is seeking a credentialing specialist to manage applications, verifications, and compliance for physicians. You will ensure licensing, certifications, and malpractice coverage are current, and serve as a liaison among providers, practice management, insurers, and regulators.

Responsibilities include primary source verification, payer enrollment with Medicare/Medicaid, maintaining CAQH and other databases, auditing files, and preparing