Credentialing Manager

We are a network of community health centers that provides care to patients in Los Angeles.

Accurately completes credentialing, privileging, re-credentialing, and re-privileging processes, including forwarding applications for credentialing and/or clinical privileges to qualified applicants and securing primary and secondary source verification in compliance with HRSA guidelines.

Ensures timely credentialing and re-credentialing of providers in accordance with industry standards and organizational policies.

Collects all necessary information from providers, malpractice insurers, the National Practitioner Data Bank (NPDB), and other pertinent sources.

Maintains accurate, up-to-date records of each application’s status, including credentialing and re-credentialing timelines and schedules.

Leads and prepares the agenda for credentialing review committee meetings and other meetings related to credentialing and privileging.

Coordinates and confirms start dates for new providers, ensuring clear communication when a provider is cleared to begin.

Maintains a strict level of confidentiality regarding credentialing and privileging information and protects the security of such data.

Processes approval, denial, and termination letters for providers.

Tracks progress of outstanding applications, reports updates, and ensures current copies of relevant credentials are maintained.

Collaborates effectively with the team to coordinate all credentialing processes and ensure compliance.

Monitors, collects, and follows up on documentation to ensure timely resolution of outstanding requests.

Conducts quality assurance reviews of completed credentialing files to ensure accuracy and completeness.

Monitors expiring applications, notifies healthcare practitioners of upcoming expiration dates for re-credentialing and re-privileging, and resolves issues ahead of deadlines.

Maintains organized healthcare practitioner files and supports internal audit processes.

Manages the annual tuberculosis (TB) documentation and sends reminders to employees for compliance.

Uploads credentialing and privileging documentation into employee profiles within the HRIS (Human Resource Information System).

Oversees the credentialing compliance database and serves as the primary point of contact with external vendors and internal partners for all credentialing- and privileging-related matters.