Remote Credentialing Specialist - Healthcare Compliance

SAN JOAQUIN COUNTY HEALTH COMMISSION; French Camp (MS); Remote; USD 57,000 - 78,000; Full time

Benefits offered by this job

Remote work policy

Health coverage

PTO & holidays

Job summary

Health Plan of San Joaquin is seeking a Credentialing Specialist to coordinate daily credentialing activities in alignment with HPSJ guidelines. The role involves data management, reporting, and collaboration across departments to ensure compliance with regulatory standards.

The ideal candidate will have 1+ year of credentialing experience, knowledge of NCQA/CMS standards, and proficiency with credentialing software. Remote work is available for CA residents with California residency.

Qualifications

• HS Diploma or equivalent is required.
• At least 1 year of credentialing experience preferred.
• Knowledge of NCQA, DHCS, DMHC and CMS credentialing standards.
• Experience with credentialing software systems such as CACTUS.

Responsibilities

• Coordinate daily credentialing operations per HPSJ guidelines.
• Maintain data collection and reporting systems; produce routine and ad-hoc reports.
• Prepare for regulatory audits and corrective action plans.
• Assist with revisions/enhancements of credentialing software and tools.
• Communicate changes to policies and procedures in a timely manner.
• Notify providers of credentialing outcomes and status changes.

Skills

NCQA credentialing standards

Medi-Cal/Medicare knowledge

Credentialing software

CACTUS software

Data reporting

Excel (formulas & pivot)

Effective communication

Education

HS Diploma or equivalent

1 year credentialing experience

Tools

CACTUS software

Job description

Health Plan of San Joaquin is seeking a Credentialing Specialist to coordinate daily credentialing activities in alignment with HPSJ guidelines. The role involves data management, reporting, and collaboration across departments to ensure compliance with regulatory standards.

The ideal candidate will have 1+ year of credentialing experience, knowledge of NCQA/CMS standards, and proficiency with credentialing software. Remote work is available for CA residents with California residency.