- Full Time/Contract
- Pasadena, CA
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.
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
$18.00/hr – $22.00/hr
Full Time; Contract