Provider Credentialing Specialist

Job Title: Provider Credentialing Specialist

Location: Apple Valley, CA

Employment Type: Full-Time

About Us

Cutting Edge Surgical Medical Group (CESMG) is a leading surgical medical practice dedicated to providing exceptional patient care through innovation, precision, and compassion. Our team of physicians, advanced practice providers, clinical staff, and administrators work collaboratively to deliver the highest standards of service in a supportive and compliance-driven environment. We are seeking a highly experienced, detail-oriented, and proactive Provider Credentialing Specialist to support our growing multi-specialty practice.

Position Overview

The Provider Credentialing Specialist is responsible for managing the full lifecycle of payer credentialing and coordinating with hospital credentialing teams to ensure all providers are properly submitted and processed for hospital privileging. This role also includes supporting the elective practice by procuring necessary referrals from insurance companies once providers are credentialed.

This is an individual contributor role that requires advanced knowledge of payer enrollment, medical staff requirements, and regulatory standards, as well as exceptional organizational skills and attention to detail. The Provider Credentialing Specialist handles sensitive information with discretion, anticipates credentialing and referral needs, ensures continuous compliance, and collaborates closely with providers, payers, hospitals, and internal leadership. Occasional travel to clinical or hospital sites may be required to support meetings or operational initiatives.

Key Responsibilities

• Manage end-to-end provider credentialing and recredentialing with commercial insurance plans, Medicare, Medicaid/Medi-Cal, and other payer entities.
• Prepare, submit, track, and follow up on all payer credentialing applications to ensure timely approvals and prevent lapses in participation.
• Maintain accurate and up-to-date provider records in NPPES, CAQH ProView, PECOS, Medicare, Medi-Cal, and other applicable state, federal, and payer credentialing systems.
• Coordinate with hospital credentialing teams to ensure all providers are submitted for hospital privileging and reappointment; track progress and ensure deadlines are met.
• Assist in the elective practice by procuring required referrals from insurance companies once providers are credentialed to ensure patient access and smooth scheduling.
• Monitor, track, and maintain provider compliance for all required credentials, including but not limited to:
• State medical licenses
• DEA registrations
• Board certifications
• Malpractice insurance and claims history
• ATLS, BLS, ACLS, PALS (as applicable)
• CME requirements
• Proactively track expiration dates and ensure timely renewals of all provider credentials, licenses, certifications, and enrollments.
• Serve as the primary liaison between CESMG, providers, payers, hospital credentialing teams, CVOs, and regulatory agencies.
• Review credentialing requirements, payer contracts, and hospital medical staff bylaws to ensure compliance with organizational, payer, and regulatory standards.
• Support provider onboarding and offboarding processes, ensuring credentialing, enrollment, and termination steps are completed accurately and efficiently.
• Maintain detailed electronic and paper credentialing files in accordance with audit, regulatory, and accreditation requirements (e.g., NCQA, CMS).
• Assist leadership with credentialing-related audits, surveys, and compliance reviews.
• Identify process improvement opportunities and implement best practices to enhance credentialing workflows, timelines, and data integrity.
• Handle all credentialing and referral information with the highest level of professionalism, discretion, and confidentiality.
• Maintain awareness of HIPAA, Medicare and Medicaid regulations, Stark Law, Anti-Kickback Statutes, and state medical credentialing requirements to ensure all practices remain compliant.

Qualifications

• Bachelor's degree in Healthcare Administration, Business Administration, or a related field preferred.
• Minimum of 7 years of experience in provider credentialing, medical staff services, or healthcare provider enrollment.
• Extensive knowledge of provider credentialing and regulatory requirements for payers, Medicare/Medicaid, and hospital privileging coordination.
• Demonstrated expertise with CAQH ProView, NPPES, PECOS, Medicare, Medi-Cal, and commercial payer portals.
• Strong understanding of HIPAA, Medicare/Medicaid regulations, Stark Law, Anti-Kickback Statutes, and state medical licensing and credentialing requirements.
• Proven ability to manage large provider rosters and complex credentialing portfolios.
• High proficiency with Microsoft Office Suite (Word, Excel, Outlook); experience with credentialing databases and EMR systems preferred.
• Exceptional attention to detail with a strong commitment to accuracy, compliance, and deadlines.
• Excellent written, verbal, and interpersonal communication skills, with the ability to interact professionally with providers, hospital teams, payers, and internal leadership.
• Strong organizational skills with the ability to manage multiple priorities independently in a fast-paced environment.
• Demonstrated professionalism, sound judgment, and discretion when handling confidential information.
• Ability to work both independently and collaboratively as part of a multidisciplinary team.
• Flexibility to travel locally to clinical or hospital sites as required.

Benefits

We value and support our employees with a competitive compensation and benefits package, including:

• Health insurance coverage
• 401(k) retirement plan with employer match
• Paid time off (PTO)
• Paid holidays

Compensation: Competitive salary based on experience; expertise in payer and hospital credentialing strongly considered.

Why Join Us?

• Be part of a mission-driven surgical medical group committed to excellence in patient care.
• Play a critical role in supporting provider operations, compliance, and patient access.
• Collaborative and professional work environment.
• Opportunities to contribute strategically and apply your expertise at a senior level.

Pay: From $40.00 per hour

Benefits:

• 401(k)
• Health insurance
• Paid time off

Work Location: In person

Salary : $40