Overview
Credentialing Specialist Jobs in Los Angeles, USA at Gracelight Community Health
Job Location:
East 3rd St Health Center – Los Angeles, CA 90022
Position Type:
Full Time
Salary Range: $24.74 – $37.10 Hourly
The Credentialing Specialist evaluates, analyzes, and coordinates all aspects of the credentialing and recredentialing process and provides integral support to operations by enabling timely onboarding of healthcare providers. The Credentialing Specialist fully manages credentialing applications, files, and historical records and ensures that medical staff members maintain current credentials and licenses to work legally in their field or specialty. The Credentialing Specialist is responsible for payor enrollment into various IPAs, health plans, state programs, and Medi-Cal/Medicare (CMS) while simultaneously tracking enrollment status.
ESSENTIAL
JOB DUTIES AND RESPONSIBILITIES
- Determines priorities and best method of completing daily workload to ensure that all responsibilities are carried out in a timely manner.
- Performs all job functions in a professional and courteous manner. This includes answering all general phone calls timely and providing excellent customer service to internal and external customers.
- Reviews and screens initial and reappointment credentialing applications for completeness, accuracy, and compliance with federal, state, local and organizational regulations, guidelines, policies, and standards.
- Conducts primary source verification, collects and validates documents to ensure accuracy of all credentialing elements; assesses completeness of information and qualifications relative to credentialing standards and organizational criteria.
- Identifies, analyzes and resolves extraordinary information, discrepancies, time gaps and other idiosyncrasies that could adversely impact ability to credential and enroll practitioners; discovers and conveys problems to leadership for sound decision making in accordance with credentialing policies and procedures, federal, state, local and government/insurance agency regulations.
- Monitors files to ensure completeness and accuracy; reviews all file documentation for compliance with quality standards, HRSA requirements, and all other relevant policies; prepares and provides information to internal and external customers as appropriate.
- Enters, updates and maintains data from provider applications into credentialing database, focusing on accuracy and interpreting or adapting data to conform to defined data field uses, and in accordance with internal policies and procedures. Files and maintains confidential credentialing and privileging files.
- Prepares, issues, electronically tracks and follows-up on appropriate verifications for efficient, high-volume processing of individual applications in accordance with applicable credentialing standards, established procedural guidelines, and strict timelines.
- Participates in the development and implementation of process improvements for the system-wide credentialing process; prepares reports as required by regulatory and accrediting agencies, policies and standards.
- Communicates clearly with providers, their liaisons, medical staff leadership, the Credentialing Committee, and administration, as needed to provide timely responses upon request on day-to-day credentialing and privileging issues as they arise.
- Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest developments to enhance understanding of various regulations and legislation of the health care industry.
- Composes, types and edits correspondence and reports, creates or modifies fillable forms, and may compose routine correspondence in ready form for executive’s signature. Handles highly sensitive information with discretion and in a professional and exemplary manner.
- Monitors approaching deadlines and plans accordingly to keep records current.
- Follows-up on appointment letters, processes requests for additional privileges and explains the reasons/s for the condition/limitation/deferment. Maintains forms and templates, and credentialed staff information.
- Drives to various clinic and administrative locations to collect signatures, deliver documents, mail or ship,…
Title: Credentialing Specialist
Company: Gracelight Community Health
Location: Los Angeles, USA
Category:
