Credentialing Support Associate III

• High school diploma or equivalent; Associate's or Bachelor's degree preferred
• Experience supporting provider credentialing, healthcare operations, provider enrollment, or administrative processes
• Experience maintaining and updating data within databases or business systems
• Strong attention to detail and commitment to data accuracy
• Excellent verbal and written communication skills
• Ability to follow established processes and regulatory requirements
• Strong organizational and time management skills
• Ability to manage multiple priorities in a deadline-driven environment
• Proficiency with Microsoft Office applications, including Excel and Outlook
• Experience with provider credentialing and recredentialing processes
• Familiarity with NCQA, CMS, state, or other healthcare regulatory requirements
• Experience conducting primary source verification activities
• Experience working with credentialing software or provider management systems
• Knowledge of healthcare provider networks and credentialing standards

You Will

• Maintain accurate provider information by entering, updating, and auditing data within credentialing systems.
• Coordinate recredentialing activities, including distributing recredentialing communications and monitoring provider responses.
• Communicate with providers to obtain missing documentation, resolve discrepancies, and ensure complete credentialing files.
• Conduct primary source verification activities for initial credentialing and recredentialing applications in accordance with regulatory requirements and company standards.
• Track and follow up on outstanding credentialing requirements to support timely processing and compliance.
• Partner with internal stakeholders to ensure provider records are accurate, complete, and compliant with organizational policies.
• Support continuous improvement efforts that enhance credentialing processes and data quality.

Reporting Relationships

As our Credentialing Support Associate III, you will report to the Credentialing leadership team.

Location

The primary location for this position is Remote with regional office in Newport Beach, CA.