Job Summary

The Credentialing Specialist supports the credentialing, privileging, and recredentialing processes for healthcare providers to ensure compliance with regulatory, accreditation, and organizational standards. This role works closely with providers, internal departments, and external agencies to maintain accurate and up-to-date credentialing records in a highly regulated healthcare environment.

Key Responsibilities

Manage initial credentialing, recredentialing, and privileging for providers in accordance with organizational policies and regulatory requirements

Verify provider credentials including education, training, licensure, board certification, work history, and professional references

Coordinate with providers to collect, review, and maintain complete credentialing documentation

Ensure compliance with federal, state, and payer requirements, including CMS, NCQA, Joint Commission, and state licensing boards

Maintain credentialing files and databases, ensuring accuracy, completeness, and timely updates

Track credential expiration dates and proactively manage renewals to prevent lapses in licensure or privileges

Prepare credentialing materials for review by credentialing committees and medical staff leadership

Respond to audits, requests for information, and payer or regulatory inquiries related to credentialing

Collaborate with internal teams such as Medical Staff Services, HR, Compliance, and Revenue Cycle

Qualifications

High school diploma or equivalent required; associate or bachelor’s degree preferred

Experience in provider credentialing, medical staff services, or healthcare administration

Knowledge of healthcare credentialing standards and regulatory requirements

Strong attention to detail and ability to manage confidential information

Experience working with credentialing databases and systems

Strong organizational, communication, and time management skills

Preferred Qualifications

Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) certification

Experience credentialing physicians, advanced practice providers, and allied health professionals

Familiarity with payer enrollment processes and managed care credentialing

Experience in a hospital, clinic, or multi-site healthcare organization

Key Competencies

Accuracy and attention to detail

Regulatory compliance and risk awareness

Organization and documentation management

Professional communication and follow-through

Ability to work independently and collaboratively

Equal Opportunity Employer / Disabled / Protected Veterans

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https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12.pdf

The pay transparency policy is available here:
https://www.dol.gov/sites/dolgov/files/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf

For temporary assignments lasting 13 weeks or longer, AppleOne is pleased to offer major medical, dental, vision, 401k and any statutory sick pay where required.

We are committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation for any part of the employment process, please contact your staffing representative who will reach out to our HR team.

AppleOne participates in the E-Verify program in certain locations as required by law. Learn more about the E-Verify program.
https://e-verify.uscis.gov/web/media/resourcesContents/E-Verify_Participation_Poster_ES.pdf

We also consider for employment qualified applicants regardless of criminal histories, consistent with legal requirements, including, if applicable, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance. Pursuant to applicable state and municipal Fair Chance Laws and Ordinances, we will consider for employment-qualified applicants with arrest and conviction records, including, if applicable, the San Francisco Fair Chance Ordinance. For Los Angeles, CA applicants: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.