Ultimate Staffing ยท 12 hours ago
Credentialing Specialist
Livingston, CA
Full-time
Onsite
New Grad, Entry Level
$22/hr - $26/hrUltimate Staffing Services is actively seeking a diligent and detail-oriented Credentialing Specialist to join their client's team in California. This role involves ensuring compliance with various regulatory and accrediting bodies, facilitating timely provider onboarding and payor enrollment, and managing facility, site, and service-line licensing.
EmploymentHuman ResourcesManufacturingStaffing Agency
Hiring Manager
Hailey Flurnoy
Responsibilities
Ensures the organization maintains compliance with HRSA, FTCA, CMS, NCQA, and other applicable regulatory and accrediting bodies, facilitating timely provider onboarding and payor enrollment
Responsible for facility, site, and service-line licensing, ensuring timely renewals, accurate postings, and alignment with payer/site enrollments
Manage the full credentialing lifecycle for licensed providers and other credentialed staff, including initial credentialing, primary source verification, and recredentialing every two years
Coordinate the privileging process, ensuring all privilege requests are complete, appropriately reviewed, and approved by the Board of Directors
Maintain accurate and complete provider files, credentialing database, and credentialing software systems
Track and verify license, DEA, BLS, malpractice insurance, board certifications, NPDB, and other required documents to ensure ongoing compliance
Coordinate and track annual peer review results and ensure the Chief Medical Officer (CMO) reviews and incorporates them into the recredentialing and reprivileging process
Prepare reports for the Quality Committee, Medical Executive Committee, and Board of Directors regarding credentialing and privileging status
Manage enrollment and re-enrollment with all contracted health plans (Medicaid, Medicare, and commercial insurers)
Prepare, submit, and track all enrollment applications, including provider adds, terminations, demographic updates, and reassignment of benefits
Maintain accurate payor rosters and CAQH profiles for all providers
Monitor effective dates and ensure billing and reimbursement are not delayed
Collaborate with the billing and revenue cycle teams to resolve enrollment-related claim denials
Maintain a comprehensive inventory of all organizational facility, site, and service-line licenses/permits/registrations, including license numbers, effective/expiration dates, scope of services, locations, and required postings
Prepare, submit, and track initial applications and renewals for facility and service-line licenses (e.g., clinic license, CLIA, radiology, lab, DME, pharmacy, and local business licenses), preventing lapses and interruptions in operations
Manage Medicare/Medicaid revalidations and state enrollment renewals for facilities
Maintain a centralized, audit-ready license repository and ensure current postings at each site; respond to payer, regulator, or accreditor requests within stated timelines
Qualification
Required
Strong understanding of credentialing and privileging processes
Experience with payor enrollment
Knowledge of facility licensing
Ability to ensure compliance with HRSA, FTCA, CMS, NCQA, and other applicable regulatory and accrediting bodies
Experience managing the full credentialing lifecycle for licensed providers and other credentialed staff
Ability to coordinate the privileging process and ensure all privilege requests are complete and appropriately reviewed
Experience maintaining accurate and complete provider files, credentialing database, and credentialing software systems
Ability to track and verify license, DEA, BLS, malpractice insurance, board certifications, NPDB, and other required documents
Experience coordinating and tracking annual peer review results
Ability to prepare reports for the Quality Committee, Medical Executive Committee, and Board of Directors regarding credentialing and privileging status
Experience managing enrollment and re-enrollment with all contracted health plans (Medicaid, Medicare, and commercial insurers)
Ability to prepare, submit, and track all enrollment applications
Experience maintaining accurate payor rosters and CAQH profiles for all providers
Ability to monitor effective dates and ensure billing and reimbursement are not delayed
Experience collaborating with billing and revenue cycle teams to resolve enrollment-related claim denials
Ability to maintain a comprehensive inventory of all organizational facility, site, and service-line licenses/permits/registrations
Experience preparing, submitting, and tracking initial applications and renewals for facility and service-line licenses
Ability to manage Medicare/Medicaid revalidations and state enrollment renewals for facilities
Experience maintaining a centralized, audit-ready license repository
Ability to respond to payer, regulator, or accreditor requests within stated timelines
Company
Ultimate Staffing
Ultimate Staffing specializes in clerical, administrative, customer service, and manufacturing and production positions.
Founded in 1994
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Lisa Marez
Partnership Director
Company data provided by crunchbase