Quality Assurance Reviewer - Credentialing

Department: Ops - Credentialing

Location: 1600 Corporate Center Dr., Monterey Park, CA 91754

Compensation: $26.00 - $28.00 / hour

• Review and process healthcare providers’ credentialing applications to ensure compliance with health plan participation requirements.
• Verify providers’ professional qualifications, including education, licensure, and certifications.
• Maintain and update credentialing records for all providers within the health plan network.
• Submit credentialing applications to health plans for review and approval.
• Monitor re-credentialing timelines, ensuring timely renewal of certifications, licenses, and memberships.
• Ensure compliance with federal, state, and health plan-specific regulations and policies.
• Collect required documentation from providers, including diplomas, licenses, certifications, and malpractice insurance.
• Address and resolve discrepancies or issues encountered during the credentialing process.
• Protect the confidentiality of sensitive provider and patient information.
• Assist with audits and respond to health plan inquiries regarding credentialing status.
• Collaborate with internal departments to resolve credentialing-related issues and maintain accurate data
  
  
  

• Bachelors degree in Business, Communications, Healthcare, or similar field.
• Proven experience in credentialing within a health plan or managed care setting.
• Strong knowledge of credentialing procedures and regulatory standards for health plans.
• Proficiency in Microsoft Office Suite (Word, Excel, Outlook).
• Excellent organizational skills and attention to detail.
• Ability to maintain confidentiality and manage sensitive information.
• Effective written and verbal communication skills.
  
  

• Certification from a credentialing organization (e.g., National Association of Medical Staff Services, NAMSS).
• Experience using credentialing software or databases.
• Familiarity with medical terminology and healthcare provider networks.
  
  
  

• Our organization follows an hybrid work structure where the expectation is to work onsite 2 days a week. This position will report to our Monterey Park office at 1600 Corporate Center Drive.
• The total pay range for this role is: $26-28/hr. This salary range represents our national target range for this role.