Remote Credentialing Specialist – Medi-Cal & CalAIM

Full Circle Health Network; California (MO); Hybrid; USD 77,000 - 85,000; Full time

Job summary

Full Circle Health Network seeks a Credentialing Specialist to coordinate provider credentialing, enrollment and ongoing file maintenance in California. You will work with providers, CBOs, MCPs and regulators to ensure timely enrollment and compliance.

This is a full-time, primarily remote/office-based role requiring CA residency. The position offers a salary range of $77,000–$85,000 and contains the potential for professional growth within a supportive network.

Qualifications

• High school diploma or equivalent required.
• Associate’s degree in Healthcare Administration, Business Administration, Public Health or related field preferred.
• Minimum three (3) years of healthcare credentialing or provider enrollment experience.
• Experience with California Medi-Cal provider enrollment.
• Experience using DHCS PAVE.
• Experience working with Managed Care Organizations.
• Experience maintaining provider credentialing records.

Responsibilities

• Coordinate provider credentialing and recredentialing.
• Prepare, submit and monitor enrollment applications through DHCS PAVE and other required enrollment systems.
• Maintain complete and current credentialing files.
• Perform primary source verification of licenses, certifications, education, sanctions, exclusions, malpractice history and other requirements.
• Monitor credential expiration dates and coordinate renewals and recredentialing.
• Monitor provider enrollment and credentialing status with Medi-Cal Managed Care Plans.
• Maintain provider demographic information and organizational records.
• Coordinate provider enrollment with MCPs, IPAs and other payer organizations.
• Respond to provider credentialing and enrollment inquiries.
• Work with CBOs to obtain required documentation.
• Assist with provider onboarding and implementation.
• Participate in credentialing audits conducted by health plans, DHCS, NCQA and other regulatory agencies.
• Prepare credentialing reports and maintain audit-ready documentation.
• Collaborate with Quality, Provider Success, Operations, IT, Compliance and Executive Leadership.

Skills

Credentialing

Enrollment

Primary source verification

Regulatory compliance

Document management

Database management

Microsoft Office

Organization & Time Management

Attention to detail

Education

High school diploma

Associate’s degree in Healthcare Administration/Business/Public Health

Tools

DHCS PAVE

Credentialing databases

Microsoft Office Suite

Job description

Full Circle Health Network seeks a Credentialing Specialist to coordinate provider credentialing, enrollment and ongoing file maintenance in California. You will work with providers, CBOs, MCPs and regulators to ensure timely enrollment and compliance.

This is a full-time, primarily remote/office-based role requiring CA residency. The position offers a salary range of $77,000–$85,000 and contains the potential for professional growth within a supportive network.