Chaparral Medical Group

Credentialing and Provider Enrollment Specialist

Chino, CA

Sponsorship not specified$48k-$67kDetected 15 days ago

Patient CareCommunicationProblem SolvingCritical Thinking

About the role

Credentialing/enrollment activities on this team include:
Filling out provider enrollment applications with health plans, Medicare, Medicaid and hospitals.
Following up with health plans and hospitals on submitted applications.

Work amongst a team of credentialing/enrollment specialists to deliver accurate, timely, and compliant work - including completing credentialing/enrollment tasks.
Maintain high data quality, including both provider data as well as credentialing data, like expiration dates, contact information, etc.
Follow SOPs and policies that are designed to streamline workflows and strengthen compliance.
Maintain compliance with the state, federal, and payer-specific credentialing requirements.
Act as a liaison for external partners, including payers, hospitals, and credentialing verification organizations.
Exceptional organization skills, with sharp attention to detail and ability to manage multiple priorities.

3+ years of experience in provider credentialing/enrollment.
Strong knowledge of NCQA standards, payer requirements, and credentialing best practices.
Excellent problem-solving and critical thinking skills, with the ability to resolve escalated issues.

Maintaining a clean database of provider data and enrollment-related activities in MD Staff.

Health benefits include medical, dental and vision
Life insurance
Solve complicated credentialing-related issues directly with IPAs and health plans.
Solve enrollment-related issues as they arise, working directly with health plans to get them resolved.

This listing is sourced directly from Chaparral Medical Group's careers page and normalized into a canonical job model.