You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.
Job Summary
Our client is seeking a Credentialing Specialist to join their team. The primary responsibility of this role is to review, process, and manage credentialing applications and enrollments for providers, ensuring compliance with federal and state requirements.
Key Responsibilities
- Review and process initial and recredentialing applications for providers in accordance with MedVanta, federal, and state requirements.
- Submit and manage enrollment applications with Medicare (PECOS), Medicaid portals (e.g., EPREP), CAQH, Availity, and other payor-specific platforms.
- Conduct primary source verification for education, licensure, board certification, malpractice, and work history per NCQA, URAC, and regulatory standards.
- Identify and resolve inconsistencies or gaps in credentialing documentation and escalate issues to the Credentialing Manager when necessary.
- Maintain accurate provider data across credentialing databases, including EHR systems and credentialing platforms.
- Ensure proper use of tools such as Modio Health, CAQH, PECOS, and internal spreadsheets for tracking provider status.
- Communicate directly with providers, internal departments, and health plans to gather required documents or respond to inquiries.
- Submit provider rosters and maintain records for delegated credentialing agreements.
- Work collaboratively within a remote or in-office team environment.
- Contribute to process improvements and uphold best practices in credentialing operations.
- Track credentialing deadlines, monitor expirables, and ensure timely renewals.
- Prepare regular status reports and documentation audits for management and regulatory agencies as needed.
- Assist in file audits and respond to requests for credentialing data from internal stakeholders.
- Perform additional tasks or projects as assigned by the Credentialing Manager.
- Performs other duties as assigned.
Qualifications
- High School Diploma Required - Bachelors preferred
- Experience with Medicare (PECOS system), Medicaid (EPREP system), and CAQH
Experience
- 3-5 years of Credentialing/Provider Enrollment experience
Skills
Benefits
- Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
- Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
- 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
- Short Term Disability Insurance.
- Term Life Insurance Plan.
*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).
Medix Overview:
With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.
*As a job position within our Revenue Cycle division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, handling financial and other payment data, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.
