Credentialing Specialist

PATH (People Assisting The Homeless) (Old); Riverside (CA); On-site; USD 3,638,000 - 4,731,000; Full time

Job summary

PATH (People Assisting The Homeless) (Old) is seeking a Credentialing Specialist in Riverside, CA. This is a full-time, non-exempt position focused on establishing, monitoring, and maintaining provider credentialing with employer groups, managed care organizations, insurance companies, medical staff offices and physicians.

You will manage licenses, renewals, and regulatory compliance, maintain credentialing files, and communicate findings to Medical Directors and supervisors.

Qualifications

• Strong organizational skills and attention to detail.
• Proficient in Microsoft Office; able to work with databases and internet apps.
• Excellent verbal and written communication; teamwork with diverse groups.
• Keeps abreast of laws and regulatory requirements.
• Maintains high standards of professionalism and ethics.

Responsibilities

• Establishes, monitors and maintains provider credentialing with employer groups, managed care organizations, and licensing bodies.
• Maintains up-to-date licenses, certifications, and renewal dates for providers.
• Processes initial credentialing applications and manages ongoing privileges.
• Queries National Practitioner Data Bank and ensures timely credentialing actions.
• Communicates with Medical and Dental Directors and reports expirations monthly.

Skills

Organizational skills

Microsoft Office

Verbal and written communication

Interpersonal skills

Regulatory awareness

Education

High school diploma

Associate's degree or equivalent

Job description

• Location 7880 Mission Grove Parkway South,Riverside, CA, 92508,United States
• Base Pay $26.41 - $34.34 / Hour
• Employee Type Full Time - Non-Exempt
• Required Degree High school

Contact information

• Name Amber Travis

Description

JOB SUMMARY:

This position is responsible for establishing, monitoring, and maintaining provider credentialing with employer groups, managed care organizations, insurance companies, medical staff office and physicians.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Upholds and supports the mission, philosophy, objectives, policies and ethics of CHSI.
• Protects organization’s value by keeping information confidential.
• Carries out and completes the credentialing process for new and existing Providers.
• Monitors, updates and advises supervisors of Provider and clinic licenses to ensure they are kept current.
• Understands and carries out the necessary process to ensure laws and regulations concerning Provider credentialing and clinic licensing are met.
• Queries electronically the National Practitioner Data Bank for initial appointment, reappointments, change in privileges, and temporary privileges for each clinic.
• Processes all initial applications for Medical/Allied Health Professional Staff appointments and clinical privileges to meet clinic operation policies and procedures.
• Maintains up-to-date license and certified Provider database, including medical licenses, drug enforcement administration (DEA) certificates, malpractice insurance, and renewal period expiration dates.
• Communicate with Medical/Dental Directors continually and provides monthly about expiration reports and provide rosters when requested.
• Maintains organized credential files and assists with inspections by regulatory authorities or accreditation surveyors, and ensures that all information meets federal and state guidelines when processing applications.
• Ensures all requests for privileges are processed in a timely manner.
• Ensures credentialing files are kept current and are in compliance.
• Responds to provider inquiries received by letter, phone, email or internal departments.
• Perform all other duties as directed either formally or informally, verbally or in writing.

SUPERVISORY RESPONSIBILITIES:

This job has no supervisory responsibilities.

KNOWLEDGE, SKILLS AND ABILITIES:

• Strong organizational skills and attention to detail; ability to manage multiple responsibilities simultaneously.
• Strong computer skills, with proficiency in Microsoft Office, database software and internet applications
• Well-developed verbal and written communication skills and the ability to work cooperatively with divergent groups
• Keeps abreast of changes in laws and regulatory requirements.
• Must possess good “customer service” including verbal and written communication.
• A high standard of professionalism and professional ethics and conduct is expected in speech, manner, attitude and appearance at all times.
• Possess strong interpersonal skills and ability to work well with others.
• Ability to deal effectively with changing situations and stressful environment.
• Ability to perform tasks related to physical activity to complete the responsibilities of the position.

EXPERIENCE AND EDUCATION:

• Minimum high school graduate or GED
• Associate's degree or equivalent from two-year college or technical school; OR
• Six months to one (1) year related experience and/or training; OR
• Equivalent combination of education and experience