What are the responsibilities and job description for the Credentialing Specialist position at optimamedical?
About Optima Medical
Optima Medical is an Arizona-based medical group consisting of 30 locations and over 130 medical providers, who care for more than 200,000 patients statewide. Our mission is to improve the quality of life throughout Arizona by helping communities “Live Better, Live Longer” through personalized healthcare, with a focus on preventing the nation’s top leading causes of death. We go beyond primary care with a full spectrum of services including cardiovascular health services, behavioral health, allergy testing and immunotherapy, in-house lab testing, imaging, chronic disease management, and other specialty health services. We aspire to aid the growth of our company by welcoming the most qualified and deserving candidates aboard.
Key Responsibilities
- Manage initial credentialing, recredentialing, demographic updates, and payer enrollment for providers across multiple states (AZ & NV)
- Monitor and track expiring licenses, DEA registrations, board certifications, malpractice insurance, and all other time-sensitive documents
- Maintain and update provider data in CAQH, PECOS, NPPES, and payer portals to ensure accuracy and compliance
- Track and follow up on all credentialing and enrollment submissions weekly to ensure timely approvals
- Support provider onboarding including new state licensure and payer network participation
- Respond to health plan and payer inquiries, resolving issues and missing documents
- Coordinate with internal departments (billing/operations) to communicate credentialing status updates and changes impacting claims or scheduling
Qualifications
- Minimum 2 years of healthcare credentialing or provider enrollment experience
- High level of professionalism with excellent written and verbal communication skills
- Strong working knowledge of CAQH, PECOS, NPPES
- Proficiency in Microsoft Excel (tracking, reporting, data management) and Microsoft Word
- Ability to manage high-volume workflows, prioritize effectively, and meet deadlines in a fast-paced environment
- Exceptional attention to detail, organization, and time management
Why join our team?
- Substantial growth opportunities
- Leadership and mentoring
- Resources to further career
- Fun work environment (lunches, events, holiday parties)
- Benefits (medical/vision/dental/401k/paid holidays)
- Supportive and positive work environment