Credentialing Specialist II

2 days ago


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

We are seeking a highly skilled Credentialing Specialist II to join our team at L.A. Care Health Plan. As a Credentialing Specialist II, you will play a critical role in ensuring the accuracy and integrity of our provider data.

Key Responsibilities:

  • Manage the credentialing process for Health Delivery Organizations (HDOs) and applicants, ensuring compliance with departmental policies and procedures, NCQA, CMS, and DHCS requirements.
  • Conduct primary source verifications, identify potential adverse events, and request additional supporting documentation as needed.
  • Enter data into CACTUS, prepare files for auditors, and present to the Credentialing Committee for decision.
  • Generate 60-day letters, scan documents into Dynafile, and notify PNO.
  • Educate and disseminate credentialing information and regulations to delegated entities.

Requirements:

  • High School Diploma or High School Equivalency Certificate.
  • At least 1 year of experience in a healthcare or managed care environment with 1 year of credentialing or a credentialing-related experience.
  • Strong knowledge of the oversight process and ability to apply requirements as per policies and procedures.
  • Professional computer skills and excellent communication skills (both verbal and written).

Preferred Qualifications:

  • Certified Medical Staff Coordinator (CMSC) or Certified Provider Credentialing Specialist (CPCS) certification.

About L.A. Care Health Plan:

L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan, serving over 2 million members.

Why Join Our Team:

We offer a wide range of benefits, including paid time off, tuition reimbursement, retirement plans, medical, dental, and vision, wellness program, and volunteer time off. Join our team and be part of an organization that makes a difference in the lives of our members and the community we serve.



  • Los Angeles, California, United States Metis Practice Solutions Full time

    Job Title: Credentialing SpecialistMetis Practice Solutions is seeking a highly organized and detail-oriented Credentialing Specialist to join our team. As a Credentialing Specialist, you will play a critical role in ensuring that healthcare providers in private practices are properly credentialed and comply with all payer and licensing regulations.Key...


  • Los Angeles, California, United States The County of Los Angeles Full time

    The County of Los Angeles Department of Health Services is seeking a skilled Credentialing Specialist to support the process of obtaining, verifying, and assessing the qualifications of physician and allied health professionals. The ideal candidate will have recent experience in a Medical Staff Services office and possess certification as a Certified...


  • Los Angeles, California, United States Nexus Hr Full time

    Credentialing Specialist Job DescriptionNexus HR is seeking a skilled Credentialing Specialist to oversee and manage the credentialing processes for healthcare professionals within our organization.About the JobThe ideal candidate will be responsible for ensuring the compliance of medical providers with legal regulations and accreditation standards. They...


  • Los Angeles, California, United States E-arth Staffing Full time

    Job SummaryE-arth Staffing is seeking a highly skilled Credentialing Specialist to join our team. As a key member of our healthcare team, you will be responsible for ensuring accurate and high-quality credentialing practices that meet regulatory and accreditation agency requirements.Key ResponsibilitiesDevelop and implement credentialing processes that...


  • Los Angeles, California, United States MedPOINT Management Full time

    Job SummaryWe are seeking a highly skilled Credentialing Coordinator to join our team at MedPOINT Management. The successful candidate will be responsible for coordinating, monitoring, and maintaining the credentialing and re-credentialing process for our providers.Key ResponsibilitiesCollaborate with CVO, credentialing staff, and provider services to ensure...


  • Los Angeles, California, United States RadNet Full time

    Job Title: Radiology Credentialing SpecialistAt RadNet, we are committed to delivering exceptional patient care and advancing the field of radiology. As a Radiology Credentialing Specialist, you will play a critical role in ensuring the accuracy and efficiency of our credentialing processes.Responsibilities:Assist with the collection and verification of...


  • Los Angeles, California, United States Planned Parenthood Los Angeles Full time

    About the RolePlanned Parenthood Los Angeles is seeking an experienced Credentialing and Compliance Specialist to join our team in Downtown Los Angeles. As a key member of our organization, you will play a critical role in ensuring the credentialing and re-credentialing process is executed efficiently and effectively.Key ResponsibilitiesLead, coordinate, and...


  • Los Angeles, California, United States RadNet Full time

    Job Title: Radiology Credentialing SpecialistAt RadNet, we are committed to delivering quality, value, and access in the 21st century. We are seeking a highly skilled Radiology Credentialing Specialist to join our team of professionals who are dedicated to achieving the best clinical outcomes.Responsibilities:Assist with the gathering of information required...


  • Los Angeles, California, United States RadNet Full time

    Credentialing Coordinator Role at RadNetWe are seeking a highly organized and detail-oriented Credentialing Coordinator to join our team at RadNet. As a Credentialing Coordinator, you will play a critical role in ensuring the accuracy and completeness of radiologist credentials, facilitating a seamless experience for our patients and providers.Key...


  • Los Angeles, California, United States JWCH Institute Full time

    Job Title: Credentialing CoordinatorJob Summary:The Credentialing Coordinator plays a vital role in ensuring the accuracy and completeness of healthcare practitioner credentials within our organization. This position is responsible for coordinating the credentialing process, maintaining accurate records, and ensuring compliance with regulatory...


  • Los Angeles, California, United States NAPA Center Full time

    Job Title: Insurance Credentialing SpecialistJob Summary:NAPA Center is seeking a highly organized and detail-oriented Insurance Credentialing Specialist to oversee the credentialing and re-credentialing process for our therapists. This role is responsible for managing applications, renewals, and maintaining accurate credentialing records in relevant...

  • Cook Specialist II

    5 days ago


    Los Angeles, California, United States State of California Full time

    About the PositionThe California Department of Veterans Affairs (CalVet) is seeking a highly skilled and dedicated Cook Specialist II to join our team at the Veterans Home of California - West Los Angeles. As a Cook Specialist II, you will play a critical role in providing exceptional culinary services to our residents, ensuring their nutritional needs are...


  • Los Angeles, California, United States PROVIDENCE, INC. Full time

    Job SummaryThe Continuing Medical Education (CME) Coordinator is responsible for developing educational programs for the medical staff to ensure compliance with regulatory agencies. This role requires strong organizational and communication skills to coordinate with medical staff and other stakeholders.Key ResponsibilitiesDevelop and implement educational...

  • Loan Specialist II

    1 day ago


    Los Angeles, California, United States INSPYR Solutions Full time

    Job Title: Loan Specialist IIAt INSPYR Solutions, we are seeking a highly skilled Loan Specialist II to join our team. As a Loan Specialist II, you will play a critical role in processing commercial and retail loans, preparing approval or closing documents, and ensuring compliance with all state and federal regulations.Key Responsibilities:Process commercial...

  • IT Specialist II

    2 weeks ago


    Los Angeles, California, United States MasTec Full time

    Job Title: IT Specialist IIOverview:MasTec Communications Group is a leading national infrastructure construction company operating throughout the United States. We are experts in cell tower construction, RF engineering, broadband fiber optic cable installation, OSP engineering, wireline construction, and emergency maintenance services.As an IT Specialist II...

  • GIS Specialist II

    1 week ago


    Los Angeles, California, United States Vanir Construction Management Full time

    Job Title: GIS Specialist IIVanir Construction Management is seeking a highly skilled GIS Specialist II to join our team. As a GIS Specialist II, you will be responsible for developing and supporting Indoors information models for wayfinding and space planning, as well as creating web and mobile geospatial applications that enable end-users to leverage...

  • GIS Specialist II

    1 week ago


    Los Angeles, California, United States CMTS Full time

    Job Title: GIS Specialist IICMTS is seeking a highly motivated GIS Specialist II to join our team in Los Angeles, CA.Job Summary:We are looking for a skilled GIS Specialist II to develop and support LAWA's ArcGIS Indoors information model (IIM) for wayfinding and space planning. The ideal candidate will have experience with ArcGIS platform, Indoors...

  • Finance Specialist II

    4 weeks ago


    Los Angeles, California, United States Metrolink Full time

    Job Title: Finance Specialist IIMetrolink is seeking a highly skilled Finance Specialist II to join our team. As a key member of our finance department, you will be responsible for performing a wide range of accounting tasks, including accounts payable and general accounting.Key Responsibilities:Accurate data entry of invoices, check requests, and expense...


  • Los Angeles, California, United States Project Support Services Full time

    Job Title: Project Controls Specialist II (Cost Analyst)Are you passionate about ensuring project success through meticulous financial management and analysis? We are seeking a highly skilled Project Controls Specialist II (Cost Analyst) to join our team at Project Support Services.As a Project Controls Specialist II (Cost Analyst), you will play a crucial...


  • Los Angeles, California, United States Solugenix Corporation Full time

    Job Title: Community Resource Center Specialist IIJoin Solugenix Corporation, a leading information technology services company, in our search for a highly skilled Community Resource Center Specialist II. This is a 3+ month contract opportunity based out of Los Angeles, CA (Onsite).About the Role:The Community Resource Center (CRC) Specialist II plays a...