Practitioner Mgmt Coord (US)

CareMore Health Management Services, LLC; Cerritos (CA); On-site; USD 33,000 - 60,000; Full time

Job summary

Mosaic Health in California is seeking a Credentialing & Enrollment Specialist to coordinate provider credentialing, recredentialing, and enrollment activities, ensuring NCQA, CMS, and state regulatory compliance. The role requires strong Excel skills, attention to detail, and excellent written and verbal communication to liaise with providers, networks, and internal teams.

You will manage inventories, review applications, conduct outreach for missing documents, track status across systems, and

Qualifications

• High school diploma or equivalent; associates or bachelor's preferred.
• Minimum 2 years healthcare credentialing or provider enrollment experience.
• Experience with health plans, provider groups, or managed care preferred.
• Strong Excel and data management skills.
• Excellent verbal and written communication.
• Ability to manage multiple priorities in a fast-paced environment.
• Knowledge of credentialing regulations and provider data management preferred.

Responsibilities

• Manage initial credentialing and recredentialing inventories to ensure timely completion.
• Review credentialing and enrollment applications for completeness and accuracy.
• Conduct outreach to providers and internal stakeholders to obtain missing documentation.
• Track credentialing status through systems and reports.
• Communicate credentialing approvals, denials, and status updates to providers and internal partners.
• Support provider enrollment activities with government and commercial payers.
• Maintain accurate provider records and databases.
• Prepare Excel spreadsheets, logs, and reports for audits.

Skills

Microsoft Excel

Verbal communication

Written communication

Attention to detail

Education

High school diploma or equivalent

Associate's degree

Bachelor's degree

Tools

CAQH

PECOS

NPPES

Availity

Job description

Job Description Summary

The Credentialing & Enrollment Specialist is responsible for coordinating and maintaining provider credentialing and enrollment activities to ensure compliance with organizational, regulatory, and health plan requirements. This role manages initial credentialing and recredentialing inventories, supports provider enrollment processes, conducts outreach for missing documentation, communicates credentialing decisions, and serves as a liaison between providers, network partners, and internal stakeholders. The position requires strong organizational skills, attention to detail, proficiency in Microsoft Excel, and excellent written and verbal communication skills.

How will you make an impact

• Manage and maintain assigned initial credentialing and recredentialing inventories to ensure timely completion and compliance with established turnaround times.


• Review credentialing and enrollment applications for completeness and accuracy.


• Conduct outreach to providers, provider groups, and internal stakeholders to obtain missing or required documentation.


• Track and monitor credentialing and enrollment status through various systems and reports.


• Communicate credentialing approvals, denials, and status updates to providers and internal business partners.


• Support provider enrollment activities with government and commercial payers.


• Maintain accurate provider records, files, and databases.


• Monitor shared departmental email inboxes and respond to inquiries in a timely and professional manner.


• Collaborate with network partners, health plans, provider offices, delegated entities, and internal departments to resolve credentialing and enrollment issues.


• Prepare and maintain Excel spreadsheets, tracking logs, and reports for operational and audit purposes.


• Ensure compliance with NCQA, CMS, state regulatory, and organizational credentialing requirements.


• Assist with credentialing audits, data validation, and special projects as assigned.


• Escalate complex issues and aging inventory items as appropriate.

Required Education and Experience

• High school diploma or equivalent required; Associate's or Bachelor\'s degree preferred.


• Minimum of 2 years of healthcare credentialing and/or provider enrollment experience.


• Experience working with health plans, provider groups, or managed care organizations preferred.


• Knowledge of provider credentialing, recredentialing, and enrollment processes.


• Knowledge, Skills, and Abilities


• Strong proficiency in Microsoft Excel, including sorting, filtering, reporting, and data management.


• Excellent verbal and written communication skills.


• Strong attention to detail and organizational skills.


• Ability to manage multiple priorities and meet deadlines in a fast-paced environment.


• Experience maintaining shared mailboxes and managing high-volume communications.


• Ability to work independently and collaboratively with cross-functional teams.


• Customer service oriented with strong problem-solving skills.


• Knowledge of credentialing regulations, accreditation standards, and provider data management preferred.

Preferred Experience

• Experience with NCQA credentialing standards.


• Experience with provider enrollment systems, CAQH, PECOS, NPPES, Availity, and state Medicaid enrollment portals.


• Experience supporting delegated credentialing or managed care network operations.

Compensation Range: $24.20 to $43.56

The anticipated base salary range represents the Company\'s good-faith estimate of the compensation it reasonably expects to pay for this position at the time of posting. Actual compensation will be determined based on factors including experience, skills, qualifications, geographic location, internal equity, and business needs.

Beware of fraudulent job postings: While Mosaic Health job advertisements may be found on many sites, our current openings page and its associated Workday account are the only places we accept applications for open roles. If you suspect a job post is fraudulent, please let us know at [e-mail]. Mosaic Health is a national care delivery platform focused on expanding access to comprehensive primary care for consumers with coverage across Commercial, Individual Exchange, Medicare, and Medicaid health plans. Learn More about Mosaic Health Learn More about Millennium Physician Group Learn More about CareMore Health Learn More about Castlight Health Learn More about Vera Whole Health