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Credentialing Specialist, Hybrid In-Office San Marcos, CA
TrueCare
Application
Details
Posted: 10-Feb-26
Location: San Marcos, California
Type: Full Time
Categories:
Admin / Clerical
Administrative, Clerical, Support Services
Sector:
Community Health Center/Community Clinic
Salary Details:
Compensation Ranges between $22-$39.70 per hour based on experience.
Required Education:
Some College
Additional Information:
2 openings available.
Internal Number: 1234
The Credentialing Specialist plays a vital role in ensuring that all healthcare providers and licensed or certified staff are properly credentialed and in compliance with internal standards and external regulatory requirements. The position is responsible for end-to-end credentialing and recredentialing processes and maintaining and updating the credentialing software systems.
Credentialing & Privileging
Collect, review, and process initial credentialing and recredentialing applications.
Ensure completeness and accuracy of all documentation, including licenses, certifications, malpractice insurance, CME, and related credentials.
Verify provider credentials such as education, training, licensure, board certifications, employment history, and references.
Conduct primary source verification by contacting licensing boards, educational institutions, and prior employers.
Process initial and reappointment applications for all licensed or certified staff.
Ensure providers are appropriately privileged and proctored according to regulatory and organizational requirements.
Query the National Practitioner Data Bank (NPDB) for OCLPs at initial credentialing and reappointment.
Track credentialing deadlines and monitor timely renewal of licenses, DEA registrations, certifications, and other required documents.
Identify and resolve discrepancies, omissions, or inconsistencies in credentialing files.
Escalate non-compliance related to licensure, certification, documentation, or reappointment.
Compliance & Quality Assurance
Ensure credentialing and privileging practices meet organizational standards, NCQA requirements, and state or regulatory agency guidelines.
Investigate complaints against providers and support resolution.
Maintain current ProAssurance malpractice certificates and non-TrueCare liability insurance.
Audit credentialing databases to ensure accuracy and data integrity.
Generate and distribute credentialing reports and prepare files for committee review.
Systems & Data Management
Maintain and update provider information in credentialing databases such as MD-Staff, CAQH, and NPPES.
Ensure accuracy, completeness, and timely entry of credentialing data.
Notify all health plan entities of provider changes, including terminations and updated business addresses.
Collaborate with the Provider Enrollment Specialist to ensure timely processing of all health plan enrollments.
Collaboration & Communication
Work closely with the Sr. Medical Staff Director to recommend improvements to credentialing and privileging workflows.
Communicate with providers, internal teams, and stakeholders to obtain missing documents and resolve inquiries.
Provide guidance and support to other credentialing staff.
Process Continuing Medical Education (CME) and licensing reimbursement requests.
Ensure credentialing and privileging practices meet organizational standards, NCQA requirements, and state or regulatory agency guidelines.
Investigate complaints against providers and support resolution.
Maintain current ProAssurance malpractice certificates and non-TrueCare liability insurance.
Audit credentialing databases to ensure accuracy and data integrity.
Generate and distribute credentialing reports and prepare files for committee review.
Qualifications:
Associate’s degree in Business, Healthcare Administration or related field.
4 to 5 years’ experience with the credentialing and privileging process for licensed independent providers (LIPs).
Strong organizational skills and attention to detail.
Possesses solid working knowledge of subject matter.
Experience with primary source verifications and collections of credentialing and privileging documentation.
Preferred Qualifications:
Bachelor’s Degree preferred.
MD Staff Credentialing Software knowledge.
National Association Medical Staff Services Certification (NAMSS).
TrueCare is a trusted healthcare provider serving San Diego and Riverside Counties, offering compassionate and comprehensive care to underserved communities. We are committed to making healthcare accessible to everyone, regardless of income or insurance status. With a focus on culturally sensitive, affordable services, TrueCare aims to improve the health of diverse communities. Our vision is to be the premier healthcare provider in the region, delivering exceptional patient experiences through innovative, integrated care.
Lead with Compassion. Elevate Patient Care. Inspire Change.