Credentialing Representative

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  • 18-00230
  • Full Time/Contract
  • Credentialing
  • Pasadena, CA
Job Description
CLIENT COMPANY OVERVIEW
Our client is committed to helping ophthalmologists and optometrists realize their full potential while providing best-in-class patient care to all those in need. They are experts in the business of providing Physician ophthalmology services with years of experience in the industry, a world-class surgeon as their founder, and an unwavering commitment to helping both established practice owners and young professionals further their ophthalmology careers.

POSITION SUMMARY
Credentialing Representative
(Ophthalmologist)

This position performs credentialing and re-credentialing activities according to company and contracted provider polices which include; CMS, Medi-Cal, health plans and IPAs (managed care)health plans. This position acts as a liaison between the provider and contracted health plans.

The manager would like someone with knowledge/experience with various payors, such as CMS, Medi-Cal, health plans and IPAs (managed care), as well as knowledge/experience credentialing Ophthalmologists.

ESSENTIAL DUTIES & RESPONSIBILITIES

  • Communicates with and completes credentialing applications and contracts with Hospitals, Health Plans, IPA’s, Medical Groups, CMS, Medi-Cal, etc.
  • Review and analyze credentialing documents for compliance; including education, eligibility, licensure, professional work history, liability insurance and malpractice history
  • Working with Ophthalmologists to complete required documentation
  • Adheres to internal credentialing processes and procedures

DESIRED QUALIFICATIONS / REQUIREMENTS
Education and Experience:

  • High school graduate or equivalent.
  • Minimum two (1-2) years full-cycle credentialing experience required
  • Skilled in independently completing all phases of the credentialing process, including but not limited to CPPA and CPPR applications
  • Knowledge and experience with Hospital, Health Plan, Managed Care, IPA, Medical Group, CMS and Medi-Cal credentialing guidelines
  • MS Office; Excel experience required
  • EMR Systems experience required

COMPENSATION
$18.00/hr – $22.00/hr

SCHEDULE
Monday Friday
(Days)

POSITION CLASSIFICATION
Full Time; Contract


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