Credentialing Lead

Are you an experienced credentialing professional looking for more than just an individual contributor role? As a Credentialing Lead, you'll be part of our credentialing and provider enrollment team — ensuring providers are credentialed and enrolled quickly and accurately with health plans and hospitals, so patients always have uninterrupted access to care. You'll bring your full credentialing expertise to the day-to-day work while also serving as the team's go-to resource for guidance, escalations, and problem-solving. It's a hands-on role with real influence — without the weight of formal management. If you're energized by improving processes and helping build a credentialing function that supports high-quality care, we'd love to meet you!

Credentialing & Enrollment (Day-to-Day)

• →Complete credentialing, re-credentialing, and privileging applications to keep providers active and patient care uninterrupted.
• →Complete provider enrollment applications and follow up with health plans, hospitals, Medicare, and Medicaid on submitted applications.
• →Resolve enrollment-related issues as they arise, working directly with health plans and IPAs.
• →Apply for license renewals and maintain accurate expiration tracking.
• →Maintain high data quality in MD Staff, including provider data, expiration dates, and contact information.
• →Maintain compliance with state, federal, and payer-specific credentialing requirements.
• →Act as a liaison for external partners, including payers, hospitals, and credentialing verification organizations.
• →Support MSO operations by processing credentialing applications and performing primary source verification in a timely and accurate manner.

Lead Responsibilities

• →Serve as the primary subject matter expert for credentialing specialists, answering day-to-day questions and providing hands-on guidance.
• →Own and manage the credentialing inbox, ensuring all incoming communications are triaged, tracked, and resolved in a timely manner.
• →Act as the escalation point for issues raised by clinics, providers, and internal teams — resolving them quickly and accurately.
• →Partner with the Credentialing leadership on special projects, process improvement initiatives, and departmental goals as needed.
• →Support onboarding of new credentialing specialists by providing training on workflows, systems, and payer requirements.
• →Provide coverage and continuity support for complex or time-sensitive credentialing tasks when needed.

• Bachelor’s degree in healthcare administration, business, or related field (preferred).
• 4+ years of experience in provider credentialing (strongly preferred)
• Strong knowledge of NCQA standards, payer requirements, and credentialing best practices.
• Excellent problem-solving and critical thinking skills, with the ability to resolve escalated issues.
• Comfortable guiding a supporting peers in a fast-paced environment.
• Exceptional organization skills, with sharp attention to detail and ability to manage multiple priorities.
• Strong written and verbal communication and interpersonal skills to collaborate cross-functionally and with external stakeholders.
• Experience with credentialing software and databases (preferred).

• This role is in-person in Pomona Valley.