•  Monitors, on an ongoing basis, all expirable credentials and documents, including medical licenses, DEA certificates, furnishing licenses, fluoroscopy certificates, board certifications, malpractice insurance, BLS certifications, and other required credentials. 
• Answers escalated departmental emails and incoming calls to the main phone line. 
• Develops and maintains a qualified medical staff by overseeing the credentialing process for all new providers and reappointments. 
• Monitors medical staff status to ensure compliance with federal and state regulations. 
• Maintains a comprehensive and accurate database of medical staff information. 
• Monitors all privileging and credentialing documents to ensure accuracy and completeness. 
• Facilitates communication between medical staff and other departments. 
• Consults with external organizations to ensure compliance with credentialing requirements. 
• Ensures all appropriate stakeholders are informed of credentialing updates and changes. 
• Participates in the development and implementation of quality improvement programs. 
• Performs other duties as assigned.

  Qualifications, Skills & Experience 

• Excellent written and verbal communication and customer service skills. 
• Ability to stay organized and perform effectively in a fast-paced, high-pressure environment. 
• Strong judgment and decision-making skills. 
• Five (5) or more years of experience managing various insurance types, including HMO, FQHC, PPO, and IPA. 
• Medicare PECOS and Medi-Cal PAVE enrollment experience required. 
• Experience with Durable Medical Equipment (DME) revalidations, reassignments, and enrollment. 
• Strong complex problem-solving skills. 
• Ability to evaluate information and ensure compliance with applicable standards. 
• Experience coaching, mentoring, and developing others. 
• Demonstrates integrity and professionalism in all interactions. 
• Adaptable and flexible in response to changing priorities and work environments. 
• Strong attention to detail and accuracy. 
• Proficient in CredentialStream, Cactus, CredentialMyDoc (CMD), Microsoft Excel, Outlook, Zoom, Microsoft Teams, Word, Adobe PDF, and internet research. 
• Ability to work effectively both independently and as part of a team. 
• Some college coursework preferred, but a degree is not required; alternatively, five (5) to ten (10) years of relevant work experience. 

Reports To: Senior Credentialing Manager