Providence Health & Services Jobs


Job Information

Providence Health & Services Credentialing Specialist in Santa Monica, California


Providence is calling a Credentialing Specialist (Full time/Day shift) at Providence Saint Johns Medical Foundation in Santa Moninca, CA.

We are seeking a Credentialing Specialist who will be responsible for processing and facilitating the credentialing, privileging and licensing and select payer activities for Providence Saint John's Medical Foundation and other Providence Medical Foundation Southern California providers. Further, the Credentialing Specialist is also responsible for the tracking and reporting of pertinent data to monitor the credentialing activities of the physician/providers providing professional medical services for Providence Saint John's Medical Foundation and Providence Medical Foundation Southern California. In addition, the specialist is knowledgeable and can respond to economic and legislative issues as they relate to Credentialing activities for Providence Saint John's Medical Foundation and Providence Medical Foundation Southern California.

In this position you will:

  • Responsible for processing the credentialing and select payer activities for Providence Physician Services (Providence Saint John’s Medical Foundation and Providence Medical Foundation Southern California) to ensure corresponding changes are made as appropriate in the necessary payer contracts

  • Responsible for processing inpatient facility privileging applications for Providence Physician Services Providers (PJNF and PMF), and coordinate between the facility’s medical staff services department and providers to expedite privileging, as needed

  • Responsible for processing the site credentialing and licensing activities for Providence Saint John’s Medical Foundation and Providence Medical Foundation Southern California sites

  • Communicate updates in credentialing data and status to appropriate departments, staff members, and physicians for corresponding contract changes

  • Format Provider Number Requests for the new providers to bill in the Providence Physician Services Practice Management Software (MDStaff), order provider numbers as needed, and update progress and changes needed to provider numbers, dependent on ongoing credentialing status

  • Process Accounts Payable functions (check requests, invoices, tracking, follow-up, distribution, communication) that are applicable to provider credentialing, privileging, or licensing

  • Maintain departmental grids and databases for credentialing, licensing, privileging and payer data within appropriate, assigned timelines. Audit grids for deficiencies and accuracy; update information as needed, disseminate information as needed and/or assigned

  • Maintenance of provider credentialing files: establish file; run appropriate queries and data bank searches; identify potential timeframe gaps or application deficiencies and requests information to correct; maintain and audit file on an ongoing basis; copy and disseminate credentialing information and documents as needed; update file as needed and/or assigned

  • Work with and provide the necessary credentialing information to the pertinent departments, staff, physicians

  • Leadership/Supervision:

  • Demonstrate awareness of risk management policies and procedures and seek guidance in handling situations, as necessary

  • Problem solving. Take initiative in solving problems by effectively utilizing staff and system resources. Seek assistance immediately from supervisor if unable to solve problems independently

  • Development:

  • Keep abreast of department policies and procedures by positively participating in staff meeting and in-services

  • Assume responsibility and accountability for own professional growth. This includes maintaining licenses as relevant, and completing all required in-service programs

  • Budgetary:

  • Compliance with Providence Physician Services operating and capital budgets


Required qualifications for this position include:

  • 4 years current experience in health care setting

  • 2 years experience in a medical credentialing environment (payer, IPA, medical group, or institutional privileging)

  • Knowledge of ICD-9 and CPT Coding desirable

  • Knowledge of physician payer credentialing, physician and allied provider privileging, and physician/provider and site regulatory licensing required

  • Demonstrates a high level skill using standard Microsoft Office desktop applications (Word, EXCEL, PowerPoint, Outlooks)

  • Must demonstrate proficiency in online credentialing applications, such as CAQH, NPDB, GSA, OIG, AMA and AOA profile service

  • Must be self motivated and organized in task completion

  • Must be detail oriented

  • Excellent communication skills

  • Must be able to speak, read, and write professionally in the English language. Must type a minimum of 35 wpm

  • Must be tactful and proficient in conflict resolution

  • Must be able to work independently and with a team

  • Must be able to deal effectively with all levels of Providence personnel, the public and physicians

Preferred qualifications for this position include:

  • Medical group experience or related area

About the hospital you will serve:

Providence Health & Services is further developing its physician integration strategy. As part of this growth, Providence Saint John’s Medical Foundation came into flourishing. Saint John’s Medical Foundation is an integrated, not-for-profit network of medical clinics and affiliated services, servicing the greater Santa Monica and Los Angeles area. The Foundation is expected to continue to grow in the next several years, bringing with it facilities, staff and physician growth to support that objective.

For information on our comprehensive range of benefits, visit:

Our Mission

As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.

About Us

Providence Health & Services is a not-for-profit Catholic network of hospitals, care centers, health plans, physicians, clinics, home health care and services guided by a Mission of caring the Sisters of Providence began over 160 years ago. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.

Schedule: Full-time

Shift: Day

Job Category: Administrative (Non-Clinical)

Location: California-Santa Monica

Req ID: 266447