Credentialing Specialist II

3 days ago


Los Angeles, California, United States L.A. Care Health Plan Full time
Credentialing Specialist II Job Summary

The Credentialing Specialist II plays a critical role in ensuring the accuracy and integrity of healthcare provider data. This position is responsible for managing the credentialing process, including initial and re-credentialing of healthcare providers, and ensuring compliance with regulatory requirements.

Key Responsibilities:
  • Manage the credentialing process, including data entry, verification, and analysis
  • Ensure compliance with regulatory requirements, including NCQA, CMS, and DHCS
  • Conduct primary source verifications and identify potential adverse events
  • Prepare files for auditors and present to the Credentialing Committee for decision
  • Generate 60-day letters and scan documents into Dynafile
  • Monitor expiring primary source verifications and update data in CACTUS
Requirements:
  • High School Diploma or equivalent
  • At least 1 year of experience in a healthcare or managed care environment
  • Strong knowledge of credentialing processes and regulatory requirements
  • Excellent communication and analytical skills
Preferred Qualifications:
  • Associate's Degree
  • Certified Medical Staff Coordinator (CMSC) or Certified Provider Credentialing Specialist (CPCS)

L.A. Care Health Plan offers a competitive salary range and a comprehensive benefits package, including paid time off, tuition reimbursement, and retirement plans.



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