Credentialing Specialist

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  • 19-00501
  • Direct Placement
  • Recruiting
  • Long Beach, CA
Job Description
Position
Credentialing Specialist

Description
The Credentialing Specialist supports the Credentialing Department by performing all duties related to credentialing and re-credentialing. The position works under the Supervision of the Department Manager.

  • Coordinate maintain and monitor Credentialing management database.
  • Update Payer Credentialing Applications and different credentialing forms.
  • Create and Maintain Provider CAQH Profiles
  • Assist providers to become contracted with different payers, including Medicare, Medical, PPO's and HMO's.
  • Assist providers to obtain hospital privileges
  • Maintain Payer Credentialing Forms. Undertake periodic audits of all forms for accuracy and changes, as well as Payer Process flow.
  • Help to develop and design innovative tools, features and workflows to improve credentialing.
  • Coordinate with the payers to ensure that all credentialing requirements are met.
  • Follow-up on submitted applications with payers and/or practice/client.
  • Proper Implementation, maintenance and continuous improvement of Quality Control, Audit and Productivity of the specified area of responsibility.
  • Assist with On-boarding of new clients and related duties as assigned.
  • Assist with Off boarding leaving clients and related duties as assigned.
  • Provide regular feedback to client/physicians and management regarding the status with their credentialing.
  • Assist in training staff when needed it.
  • Perform other various related duties and assists with special projects as assigned.
  • Reports any compliance areas of concern to Department Manager.

Requirements

  • Minimum of (1) to (2) years of credentialing experience required.
  • High School diploma
  • Excellent analytical, organization and time management skills.
  • Ability to exercise a high level of tact and discretion in both, internal and external interactions.
  • Excellent written and verbal communications skills
  • Positive communicator and Team player
  • Problem solving and critical thinking
  • Must have credentialing knowledge and familiarity with industry recognized standards.
  • Proficient in office communication systems (e-mail programs), MS Word, MS Excel, MS PowerPoint.
  • Experience with IntelliCred credentialing system a plus.
  • Must be confident, creative and self-motivated and enthusiastic

Compensation
$19.00 – $24.03 

Additional Information
Monday – Friday 8:00 – 5:00
Direct Hire – Full Benefits


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