Current jobs related to Credentialing Specialist - Rancho Cordova, CA - ObjectWin Technology
-
Trucking Claims Specialist
6 days ago
Rancho Cordova, CA, United States Berkshire Hathaway GUARD Insurance Companies Full timeOverview Good things are happening at Berkshire Hathaway GUARD Insurance Companies. We provide Property & Casualty insurance products and services through a nationwide network of independent agents and brokers. Our companies are all rated A+ “Superior” by AM Best (the leading independent insurance rating organization) and ultimately owned by Warren...
-
Trucking Claims Specialist
2 weeks ago
Rancho Cordova, CA, United States Berkshire Hathaway GUARD Insurance Companies Full timeOverview Good things are happening at Berkshire Hathaway GUARD Insurance Companies. We provide Property & Casualty insurance products and services through a nationwide network of independent agents and brokers. Our companies are all rated A+ “Superior” by AM Best (the leading independent insurance rating organization) and ultimately owned by Warren...
-
Trucking Claims Specialist
1 week ago
Rancho Cordova, CA, United States Berkshire Hathaway GUARD Insurance Companies Full timeOverview Good things are happening at Berkshire Hathaway GUARD Insurance Companies. We provide Property & Casualty insurance products and services through a nationwide network of independent agents and brokers. Our companies are all rated A+ “Superior” by AM Best (the leading independent insurance rating organization) and ultimately owned by Warren...
-
Trucking Claims Specialist
1 week ago
Rancho Cordova, CA, United States Berkshire Hathaway GUARD Insurance Companies Full timeOverview Good things are happening at Berkshire Hathaway GUARD Insurance Companies. We provide Property & Casualty insurance products and services through a nationwide network of independent agents and brokers. Our companies are all rated A+ “Superior” by AM Best (the leading independent insurance rating organization) and ultimately owned by Warren...
-
Trucking Claims Specialist
1 week ago
Rancho Cordova, CA, United States Berkshire Hathaway GUARD Insurance Companies Full timeOverview Good things are happening at Berkshire Hathaway GUARD Insurance Companies. We provide Property & Casualty insurance products and services through a nationwide network of independent agents and brokers. Our companies are all rated A+ “Superior” by AM Best (the leading independent insurance rating organization) and ultimately owned by Warren...
-
SEXUAL VIOLENCE PREVENTION SPECIALIST
5 days ago
Rancho Cordova, CA, United States Army National Guard Units Full timeSummary This SEXUAL VIOLENCE PREVENTION SPECIALIST (PREV WF) is located at the JFHQ-State reporting to the Primary Prevention Officerand is part of the CA CHQC Joint Staff. Duties Help THIS IS A T5 EXCEPTED SERVICE, PERMANENT POSITION The primary purpose of the SEXUAL VIOLENCE PREVENTION SPECIALIST (PREV WF), GS-0101-12, is to directly support the...
-
Claim Operations Specialist
1 week ago
Rancho Cordova, CA, United States Travelers Insurance Full timeWho Are We? Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what...
-
Claim Operations Specialist
1 week ago
Rancho Cordova, CA, United States Travelers Insurance Full timeWho Are We? Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what...
-
Medical Assistant Part Time
6 days ago
Rancho Cordova, CA, United States Concentra Careers Full timeOverviewMedical Assistant - Per DiemLocation: Rancho Cordova The Medical Assistant is responsible for performing routine medical and testing procedures under direct supervision of the treating clinician as well as supports in other areas of the facility as needed including registration and referral management. This role requires efficient and accurate...
-
Medical Assistant Part Time
2 weeks ago
Rancho Cordova, CA, United States Concentra Careers Full timeOverviewMedical Assistant - Per DiemLocation: Rancho Cordova The Medical Assistant is responsible for performing routine medical and testing procedures under direct supervision of the treating clinician as well as supports in other areas of the facility as needed including registration and referral management. This role requires efficient and accurate...
Credentialing Specialist
3 weeks ago
Remote
6 Month contract
Job Summary
The Provider Credentialing Specialist is responsible for managing all aspects of provider credentialing and recredentialing in compliance with state and regulatory requirements. This role partners closely with providers, retail chains, internal stakeholders, and regulatory bodies to ensure accurate, timely, and compliant credentialing decisions while supporting organizational growth and operational objectives.
Key Responsibilities
Develop and maintain productive relationships with providers, retail chains, strategic partners, and their staff.
Educate providers on industry-standard credentialing requirements by leveraging internal team knowledge and resources.
Establish and manage provider relationships to obtain required regulatory and credentialing documentation.
Independently review and validate documentation to ensure compliance with applicable state and regulatory requirements.
Oversee and manage assigned provider files within the CVO partner system.
Track in-progress credentialing files, identify missing documentation, and ensure timely completion for new and existing providers.
Research, analyze, and resolve complex credentialing issues and escalations, collaborating with internal and external partners as needed.
Use analytical and investigative skills to evaluate information from regulatory agencies, legal documents, and providers related to sanctions or malpractice claims.
Compile complete and accurate credentialing packets for presentation to the Credentialing Committee to support informed decision-making.
Maintain accurate provider data and ensure the integrity of all shared credentialing information.
Escalate issues appropriately and drive resolution in partnership with relevant business areas.
Gather and assess documentation required by the Legal Department for dispute resolution processes involving denied or terminated providers.
Prepare clear, professional, and concise correspondence for providers, retail chains, and office staff.
ct as an internal subject matter resource for credentialing-related inquiries.
Demonstrate understanding of organizational strategy and contribute to achieving growth and operational goals.
Required Qualifications
Bachelor's degree in a related field OR 4 years of relevant functional experience in lieu of a degree.
Experience working directly with providers and office staff on credentialing policies and procedures.
Demonstrated professionalism and leadership when managing conflict, controversy, and escalated situations.
Strong analytical, investigative, and problem-solving skills.
bility to exercise discretion and independent judgment in day-to-day responsibilities.
Excellent written and verbal communication skills, with the ability to influence and collaborate effectively.
Strong attention to detail with proven multitasking and organizational capabilities.
Customer-focused mindset with the ability to balance provider needs and corporate objectives.
bility to work independently as well as collaboratively in a team environment.
Preferred Skills (Nice to Have)
Experience working with CVO systems or credentialing databases
Familiarity with healthcare regulatory and compliance standards
Prior experience supporting Credentialing Committees
