Credentialing Specialist

Brief Description

of the Paskenta Band of Nomlaki Indians Tribal Policies). Applicants claiming Indian Preference must submit verification of Indian certified by tribe of affiliation or other acceptable documentation of Indian heritage.

The Credentialing Coordinator serves as Rolling Hills Clinic's internal owner and central point of coordination for provider credentialing, privileging, recredentialing, payer enrollment, onboarding readiness, provider records, professional-license oversight, CAQH and payer-portal administration, and related organizational communication. The position works closely with contracted credentialing and payer enrollment vendors and ensures each provider file is initiated, supported, tracked, completed, communicated, and maintained.

Native Preference in hiring is given to qualified enrolled members of Paskenta Band of Nomlaki Indians and Native Americans in accordance with the Band’s Preference Policy,
Chapter 1-715 of the Paskenta Band of Nomlaki Indians Tribal Policies). Applicants claiming Indian Preference must submit verification of Indian certified by tribe of affiliation or other acceptable documentation of Indian heritage.

The Credentialing Coordinator serves as Rolling Hills Clinic's internal owner and central point of coordination for provider credentialing, privileging, recredentialing, payer enrollment, onboarding readiness, provider records, professional-license oversight, CAQH and payer-portal administration, and related organizational communication. The position works closely with contracted credentialing and payer enrollment vendors and ensures each provider file is initiated, supported, tracked, completed, communicated, and maintained.

This role does not duplicate the technical services assigned to the vendors. The vendors perform specialized processing; the Credentialing Coordinator manages Rolling Hills Clinic's internal workflow, documents, approvals, deadlines, portals, records, communication, and accountability.

• Receive notification of new employees, locum tenens providers, contractors, and other practitioners requiring credentialing or payer enrollment.
• Initiate credentialing, privileging, and payer enrollment requests with the appropriate contracted vendors.
• Distribute provider applications, instructions, and document requests; monitor completion and follow up on missing or incomplete information.
• Track anticipated start dates, onboarding dependencies, clinical approval, payer readiness, and outstanding requirements.
• Maintain a consolidated provider-readiness tracker across medical, dental, specialty, behavioral health, and physical therapy service lines.
• Coordinate provider status and readiness information with Human Resources, site managers, Operations, clinical leadership, Revenue Cycle, and other authorized stakeholders.

• Serve as the primary organizational liaison for the credentialing, privileging, recredentialing, and re-privileging contractor.
• Submit complete provider intake information and organizational documents to the contractor and respond promptly to follow-up requests.
• Coordinate Medical and Dental Director review, recommendations, peer review or competency documentation, and governing-body approval workflows in accordance with organizational policy.
• Track initial credentialing, temporary privilege, privilege, recredentialing, and reappointment deadlines.
• Confirm completed files are returned, retained, and available for internal review, audit, accreditation, or regulatory purposes.
• Escalate missing documents, delays, discrepancies, or expiring approvals that may affect provider start dates or continued practice.

• Serve as the primary organizational liaison for the payer enrollment contractor.
• Initiate provider additions, reassignments, enrollments, demographic changes, location changes, and terminations with applicable payers.
• Provide requested organizational records, signatures, rosters, taxonomies, location information, and supporting documents.
• Track submissions, payer requests, effective dates, unresolved issues, and enrollment completion.
• Communicate payer participation and effective dates to Revenue Cycle, billing teams, Operations, and other authorized stakeholders.
• Identify and escalation enrollment gaps that may delay billing, extend claim holds, contribute to timely-filing denials, or result in write-offs

• Maintain complete, organized, secure, and audit-ready provider files and internal tracking records.
• Maintain organizational access and provider affiliations within Availity and other payer portals.
• Manage CAQH profile maintenance, document uploads, authorizations, data updates, and required attestations.
• Complete or coordinate payer-directory, roster, and portal attestations within required…