Provider Credentialing Specialist

MemorialCare Health System; Fountain Valley (CA); On-site; USD 52,000 - 72,000; Full time

Job summary

MemorialCare is seeking a Credentialing Clerk to support Physician Billing Services by obtaining, maintaining, and renewing physician credentials with third-party payers. You will coordinate credentialing and recredentialing, monitor expiration dates, and ensure timely completion of documentation.

Responsibilities include submitting payer applications, tracking statuses, and maintaining confidential files, with a focus on accuracy and compliance.

Qualifications

• High school diploma or GED required.
• Experience with MS Word, Excel, Outlook and data entry.
• Basic administrative ability including filing, scanning, and multi-line phones.
• Strong customer service and professional communication with physicians and executives.

Responsibilities

• Obtain and maintain physician data for credentialing programs and update CAQH profiles.
• Submit payer applications and enrollment packets for new credentials or recredentialing with commercial plans and government programs.
• Track renewal dates and follow up on incomplete applications to minimize delays.
• Notify departments of approved credentials when received from payers.
• Maintain secure confidential provider files and documentation.
• Ensure readiness for audits by maintaining current compliance documentation.

Skills

Data entry

MS Word

MS Excel

MS Outlook

Customer service

Professional communication

Education

High school diploma or GED

Associate degree in Healthcare Administration or Business

Job description

MemorialCare is seeking a Credentialing Clerk to support Physician Billing Services by obtaining, maintaining, and renewing physician credentials with third-party payers. You will coordinate credentialing and recredentialing, monitor expiration dates, and ensure timely completion of documentation.

Responsibilities include submitting payer applications, tracking statuses, and maintaining confidential files, with a focus on accuracy and compliance.