Credentialing Specialist

Credentialing Specialist Location: El Segundo Role Summary: Responsible for processing provider credentialing, contracting, and privileging as well as responding to medical record requests. Handles end-to-end processing of internal credentialing, re credentialing and privileging processes for all medical providers who provide patient care and partners with external credentialing and contracting teams. Responsible for ensuring providers and facilities are appropriately credentialed, appointed, and privileged with health plans including Medicare, hospitals and patient care facilities. Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications. Acts as the primary point of contact for medical record requests. Based on type, routes different medical record requests to appropriate teams, tracks, and follows up to ensure all requests are completed in a timely manner. As needed, works with legal team to directly fulfill requests for records. Ensures accuracy, timeliness, and confidentiality in response to all request for medical records. Role Description: -Compiles and maintains current and accurate data for all providers. -Completes provider credentialing and re credentialing applications; monitors applications and follows-up as needed. -Compiles, tracks and maintains current and accurate data for all providers including copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers. -Maintains corporate provider contract files. -Maintains knowledge of current health plan and agency requirements for credentialing providers. -Sets up and maintains provider information in online credentialing databases and system. -Tracks license, vaccination, and certification expirations for all providers to ensure timely renewals. -Ensures practice addresses are current with health plans, agencies and other entities. -Processes applications for appointment and reappointment of privileges -Maintains appointment files, and information in credentialing database. -Audits health plan directories for current and accurate provider information. -Routes medical and billing record requests to the responsible team, tracks all requests, and ensures timely response regardless of which team is fulfilling the request. -Works with the Legal team and directly fulfills medical and billing record requests. -Maintains ongoing, accurate tracking of medical record requests and fulfillment. Additional Responsibilities:-Maintains confidentiality of provider and patient information. -Provides credentialing and privileging verifications. -Performs other duties as assigned. Qualifications: Education: High school diploma or equivalent. Associate degree preferred.

Created: 2026-04-02