Location: Montebello, California
Schedule: Monday through Friday 8a to 5p
Pay: $23 to 26
Requirements: 3 years health care credentialing experience 
Job Type: temporary

Summary:

The Credentialing Coordinator is responsible for processing initial and reappointment credentialing applications for physician and mid-level providers including dental providers. The Credentialing Coordinator works collaboratively with all members of the credentialing department, Administration, physicians and health care providers to coordinate, develop, monitor and maintain the credentialing process. Ensures accurate, complete and timely functioning of the appointment and reappointment processes. Prepares credentialing files for presentation to the Credentialing Committee as well as to State Agency and Health Plans audits.

Responsibilities:

1. Executes appointment and reappointment applications to assure time frames are met and in accordance to Credentialing regulatory standards.
2. Responsible for continuous collection of information pertaining to physicians, dentist, mid-level providers and Ancillary facilities, follows-up for missing and/or expired information to comply with regulatory agencies and credentialing policies.
3. Completes the investigative process for appointment and re-appointment applications and works with credentialing supervisor to finalize application if applicable.
4. Appropriately completes and processes all inquiries to the National Practitioner Data Bank, AMA/AOA and other essential verifications for all initial and reappointment applications.
5. Diligently initiates all follow-up communications required to adequately research and secure information necessary to facilitate the committee's goals.
6. Responsible for the accuracy and integrity of data entered into the credentialing database system.
7. Prepare appropriate reports before and after Credentialing Committee such as agenda, minutes, etc.
8. Actively participates in committee meetings, and other pertinent meetings required to facilitate credentialing process.
9. Facilitate external reporting as needed, including, but not limited to health plan requirements, corrective action plan, 805, etc.
10. Actively participate in annual health plan audits, including corrective action plans as needed.

Qualifications

1. Some college coursework or Associates degree preferred.
2. A minimum of 3 years experience in the field of Health Care Credentialing.
3. Certified Provider Credentialing Specialist (CPCS) preferred.

Skills and Abilities

1. Establishes and maintains long-term customer service relationships, building trust and
respect consistently meeting and exceeding expectations.
2. Proactively prioritizes needs and effectively manages resources.
3. Strong attention to detail and highly organized.
4. Ability to work independently within their assigned population.
5. Strong written, oral and verbal communication skills.
6. Demonstrate proficiency in computer software programs (i.e. Microsoft office and
credentialing database maintenance).
7. Knowledge of medical terminology.
8. Knowledge of HIPAA Guidelines including the Protected Health Information (PHI) privacy requirements.
9. Knowledge of credentialing policies and procedures, and credentialing requirements
including TJC, NCQA, and State, federal other regularly agencies.