Credentialing specialist Jobs in Bakersfield, CA

Job Overview :

The Contracting & Credentialing Coordinator, under the direct supervision of the Billing Manager and the Director of Finance & Billing, is responsible for coordinating provider and facility licensing, credentialing, and contracting across all applicable regions and health plans. This role involves working cooperatively with various teams including AUC Leadership, HR, Recruiting, Providers, Operations, Billing, and the Owners to ensure timely and accurate contracting and credentialing for our rapidly growing organization.

Essential Responsibilities :

Assist with provider and facility licensing, credentialing, and contracting to ensure claims are paid and cash flow is not disrupted.

Maintain tracking databases of required provider and facility licenses, certifications, contract statuses, and credentials; review and update this critical data and associated documents on an ongoing basis to ensure compliance.

Maintain AUC’s provider roster to meet organizational goals and staffing needs.

Proactively monitor provider licensing to ensure compliance with payers, including reviewing practitioner licenses, DEA licenses, and ACLS certifications. Communicate provider and plan statuses to all stakeholders, including AUC Leadership.

Provide contracting and credentialing support to various departments, teams, and individuals within the organization as needed to fulfill business needs.

Partner with health plan representatives to promptly follow up and execute provider and plan approval dates.

Work with the Billing Manager to track executed health plan agreements, ensuring claims are billed correctly per the executed agreement.

Ensure new health plan contracts and their effective dates are communicated to the appropriate Operations Managers for staff notification and education purposes.

Communicate the roster of new providers to the Billing Team as they are onboarded to ensure claim reimbursements are maximized.

Coordinate new provider credentialing, including sending welcome emails to new providers and assisting with any questions or concerns. Troubleshoot barriers quickly under AUC Leadership guidance to avoid delays in credentialing approvals.

Submit professional liability applications to our broker representative and frequently follow up on approval statuses.

Coordinate and maintain the Supervising Physician matrix along with associated collaborative agreements, under AUC Leadership guidance, to remain in compliance with Medical Board and health plan requirements.

Submit Letters of Intent to health plans or medical groups not yet contracted with, as needed. Educate and build relationships with health plan groups to expedite the contracting process.

Minimum Requirements | Qualifications :

2+ years of experience working with various plan types such as Medi-Cal, Medicare, HMO, PPO, etc., preferably in an urgent care setting.

High school diploma or equivalent.

Position Details :

Position Type : Full-time, Exempt

Position Hours : Monday through Friday, 8am-5pm

Job Type : Full-time

Benefits : Medical, Dental, Vision, Life, and PTO + Stocked Coffee Bar

Additional Skills & Qualifications :

• Experience working within an Urgent Care setting.

Experience Level : Entry Level

Pay and Benefits

The pay range for this position is $22.00 - $25.00 / hr.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following :

Workplace Type

This is a fully onsite position in Bakersfield,CA.

Application Deadline

This position is anticipated to close on Mar 14, 2025.

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

Diversity, Equity & Inclusion

At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through :

Hiring diverse talent

Maintaining an inclusive environment through persistent self-reflection

Building a culture of care, engagement, and recognition with clear outcomes

Ensuring growth opportunities for our people

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email [email protected] (%[email protected]) for other accommodation options.