Credentialing Specialist (Medi-Cal, Anthem CA, Kaiser Experience Required)

About Us

We are a growing healthcare organization committed to delivering exceptional patient care through innovative and collaborative clinical services. As we expand our partnerships across California, we are looking for a detail-oriented and experienced Credentialing Specialist to join our team and help ensure timely and accurate provider onboarding with payers.

Position Overview

The Credentialing Specialist will manage and execute all aspects of the credentialing process for healthcare providers. The ideal candidate has hands-on experience with Medi-Cal (California Medicaid), Anthem Blue Cross of California, and Kaiser Permanente, and can confidently navigate the submission, follow-up, and troubleshooting processes required by these payers.

Key Responsibilities

1. Prepare, submit, and track credentialing and re-credentialing applications for providers across Medi-Cal, Anthem CA, and Kaiser.

2. Monitor credentialing timelines and proactively follow up with payers to avoid delays.

3. Serve as the primary point of contact for credentialing-related communications with health plans and internal teams.

4. Identify and escalate issues or delays as needed, and support resolution efforts to ensure timely approvals.

5. Stay up to date with changes in payer policies and credentialing requirements.

Requirements

1. Minimum 2 years of credentialing experience in a healthcare setting.

2. Direct experience credentialing providers with Medi-Cal, Anthem Blue Cross of California, and Kaiser Permanente.

3. Experience credentialing behavioral-health providers.

4. Strong understanding of payer-specific requirements, CAQH, and NPPES systems.

5. Excellent attention to detail, organizational skills, and follow-through.

6. Proficiency in Google Workspace (Docs, Sheets) or Microsoft Office Suite.

Strong communication skills and ability to work independently and collaboratively.