Credentialing and Provider Enrollment Specialist
Summary
Process provider credentialing and enrollment paperwork with health plans and hospitals to ensure providers stay active and patients have uninterrupted care.
Company Overview
Over the past 40 years, Chaparral Medical Group (CMG) has established itself as a leading primary and multi-specialty care provider for California’s Inland Empire. In 2022, CMG joined forces with Akido Labs, a tech-enabled healthcare company, to transform the healthcare experience from the ground up. This partnership joins CMG’s medical services with Akido’s innovative technology to relieve the frustrations felt by everyone involved in care delivery, from medical providers and their staff, to the patients and their families. Ultimately, this means our providers spend more time caring for patients and less time bogged down with administrative work.
As part of the Akido medical network, we are currently responsible for more than 250,000 patients in Southern California, with plans to expand into new markets across the U.S. We care deeply about the communities we serve and are committed to providing accessible, high quality healthcare that helps our patients and communities live their fullest lives. We're building a dynamic, diverse and driven team as we continue to grow and broaden our impact. We are seeking passionate people who care deeply about helping patients and communities. We hope you’ll join our team
The Opportunity
Are you driven to build the systems that keep healthcare running seamlessly? As a Credentialing / Provider Enrollment Specialist, you’ll be part of our credentialing/provider enrollment team to ensure providers are credentialed and enrolled quickly and accurately with health plans and hospitals — so patients always have uninterrupted access to care.
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.
- Solve complicated credentialing-related issues directly with IPAs and health plans.
- Maintaining a clean database of provider data and enrollment-related activities in MD Staff.
- Applying for license renewals.
- Communicating with providers on credentialing-related updates.
This is a hands-on role where you will work with the Credentialing Supervisor and fellow Provider Enrollment Coordinators to ensure all work is completed in a timely and accurate fashion. If you’re energized by improving processes and building a credentialing function that supports high-quality care, we’d love to meet you!
What You’ll Do
- Work amongst a team of credentialing/enrollment specialists to deliver accurate, timely, and compliant work - including completing credentialing/enrollment tasks.
- Process credentialing, re-credentialing, and privileging applications to keep providers active and patient care uninterrupted.
- Solve enrollment-related issues as they arise, working directly with health plans to get them resolved.
- Monitor application timelines to prevent delays and resolve escalated issues from staff, clinics, and providers.
- 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.
Who You Are
- Bachelor’s degree in healthcare administration, business, or related field (preferred).
- 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.
- Exceptional organization skills, with sharp attention to detail and ability to manage multiple priorities.
- Strong written and verbal communication and interpersonal skills to collaborate cross-functionally and with external stakeholders.
- Experience with credentialing/enrollment software and databases (preferred).
Benefits
- Health benefits include medical, dental and vision
- Life insurance
- Paid leaves
Location
- This role is in-person in Pomona, CA.
Chaparral Medical Group and Akido MSO are an equal opportunity employers, and we encourage qualified applicants of every background, ability, and life experience to contact us about appropriate employment opportunities.