Credentialing Assistant

APLA Health; Los Angeles (CA); Hybrid; USD 25,000 - 30,000; Full time

Job summary

APLA Health is seeking a Credentialing Assistant in Los Angeles to support daily administrative tasks related to provider credentialing. You will assist with populating credentialing applications for medical, behavioral, and dental providers and help maintain enrollment data.

Responsibilities include coordinating with health plans, updating Paycom with credentialing statuses, and ensuring quarterly verification of provider credentials and locations.

Qualifications

• Assists with populating credentialing applications and maintains accurate records.
• Supports onboarding of new Medical, Behavioral, and Dental providers.
• Manages data entry and tracking in Paycom and health plan enrollment spreadsheets.
• Communicates with health plans to check status at 15–30 days.
• Organizes training reminders and ensures compliance with plans.

Responsibilities

• Populate credentialing applications for providers to expedite submissions.
• Enter effective dates and credentialing status into Paycom.
• Maintain Health Plan Enrollment spreadsheets with statuses and dates.
• Coordinate quarterly provider locations and schedules with Clinic Directors.
• Ensure providers are credentialed/enrolled with all health plans.

Skills

Credentialing

Organizational skills

Attention to detail

Communication skills

Outlook

Microsoft Word

Microsoft Excel

Education

AA degree

High School Diploma

Tools

Paycom

Job description

Requisition #: 52071Status: Full-time, Non-ExemptSchedule: Monday – Friday, 8AM – 5PMOnsite or Hybrid: Hybrid - onsite 3 days per week. Will need to conduct orientation/training onsite.Bilingual (English/Spanish): NoPOSITION SUMMARY:Credentialing Assistant will report to the Credentialing Supervisor Will assist with the daily administrative tasks related to provider credentialing.ESSENTIAL DUTIES AND RESPONSIBILITIES:Assists with populating credentialing applications for providers to expedite submission to health plans.Assists with credentialing applications for new Medical, Behavioral, and Dental provider(s).Contacts health plans on a 15–30-day mark to check in on status of credentialing application submissions.Assists with uploading all credentialing-related files onto Paycom when received (credentialing approvals, rejections, terminations, recredentials, etc.).Inputs effective dates and credentialing status into Paycom.Records credentialing-related data in the Health Plan Enrollment spreadsheet including, but not limited to effective & expiration dates, credentialing status information, demographic updates, terminations, etc.Notifies Billing & Credentialing work group when all health plan credentialing applications have been submitted & when provider is fully enrolled into all health plans.Connect with Clinic Directors on a quarterly basis to confirm provider service locations and schedules. Updates schedule on provider information spreadsheet.Verifies with each health plan (phone call, email, roster, etc.) all providers are actively credentialed/enrolled on a quarterly basis.Attests portal & directory verifications required by specific health plan accounts/websites.Sends training(s) when required from the health plans. Tracks completion of training(s) before due date to ensure provider is being compliant.Submits demographic changes for providers when needed (changes in service location, schedule, leave status, name, patient acceptance, etc.).Retrieves and uploads current roster from health plan if applicable on a quarterly basis.Assists with provider terminations from each health plan when they leave the agency and with updating all tracker sheets.CAQH follow-ups and current document uploads (updated licenses, DEAs, insurances).OIG Streamline Verify monthly checks for all employees (if we keep this in credentialing).Annual NP Protocols/PA Practice agreements.Privileging request follow-ups (for those already credentialed and who need to renew).OTHER DUTIES MAY BE ASSIGNED TO MEET BUSINESS NEEDS.REQUIREMENTS:Training and Experience:Must possess an AA degree and have 2 years of credentialing or administrative experience or a High School Diploma and 4 years’ experience. Must be organized, computer savvy and detail oriented. Possess clear and effective oral and written communication skills. Knowledge of health plan enrollment, or prior health care experience preferred.Knowledge of:Outlook, Microsoft Word and Microsoft Excel, Paycom (Preferred).Ability to:Meet all deadlines, be persistent, strong organizational skills and detail oriented. Work with people of diverse cultural, educational, social and economic backgrounds. Must have willingness to learn process of Credentialing.WORKING CONDITIONS/PHYSICAL REQUIREMENTS:This is primarily an office position that requires only occasional bending, reaching, stooping, lifting and moving of office materials weighing 25 pounds or less. The position requires daily use of a personal computer and requires entering, viewing, and revising text and graphics on the computer and on paper.SPECIAL REQUIREMENTS:COVID-19 Vaccination or Medical/ Religious Exemption required.Equal Opportunity Employer.