Credentialing Specialist

At Clinica Family Health & Wellness, we believe everyone deserves high-quality, compassionate healthcare close to home. We are a nonprofit Federally Qualified Health Center (FQHC) that provides comprehensive, affordable medical, dental, behavioral health, pharmacy, and specialty behavioral care services. We are committed to being a healthcare home for our patients, a place where they receive coordinated, whole-person care from a team that supports their health and well-being at every stage of life.

“Your work will help ensure we stay compliant, maintain malpractice coverage, and receive payment for the care we provide. Without it, we couldn't support our providers, sustain our operations, or continue serving patients. In many ways, this role is a critical part of how we make patient care possible.” ~ Catie, Director of Revenue Cycle

• Education: High school diploma or GED required.
• At least three (3+) years’ experience in healthcare provider credentialing, privileging, or enrollment or a closely related administrative function required.

• Are you someone who stays organized and enjoys tracking multiple tasks, deadlines, and follow-ups at the same time?
• Do you communicate confidently and professionally with people at all levels, whether in person, over the phone, or through email?
• Have you ever researched complex issues, made multiple calls, and tracked down information across different systems to find the right answer?
• Are you comfortable working in situations where the process is not always clear and figuring out the next steps independently?
• Do you ask detailed questions and use critical thinking to solve problems and connect the dots when information is missing?
• Have you managed detail-oriented work that requires a high level of accuracy and attention to detail?
• Do you thrive in a fast-paced environment where you are managing 10-15 provider records a month learn new software systems quickly, and maintain a positive attitude while adapting to changing priorities?

• →Review and prioritize items such as incoming staff inquiries, payer notices, credentialing requests and privileging and payor enrollment in the shared inbox, personal email, and ticketing system, responding to questions and following up on outstanding requests.
• →Monitor credentialing status, Medicare, Medicaid, and other enrollment applications, ensuring timely follow-up on in-progress items.
• →Support new provider onboarding by conducting outreach, gathering required documentation, and tracking outstanding requirements.
• →Assess provider credentialing and enrollment lifecycle and take steps to move applications forward.
• →Track upcoming license expirations and coordinate renewals to maintain provider compliance.
• →Prepare and submit provider roster updates to payors, ensuring new providers are added accurately and in a timely manner to support reimbursement.
• →Communicate regularly (what is regular? Daily, weekly, monthly or just delete the word “regularly”) with providers, payors, and internal partners to resolve issues, answer questions, and keep processes moving.
• →Adapt priorities based on business needs, deadlines, and the status of active credentialing and enrollment projects.