Managed Care Credentialing Coordinator

Northeast Community Clinic; Alhambra (CA); On-site; USD 42,000 - 64,000; Full time

Job summary

Northeast Community Clinic is seeking a Credentialing Coordinator to manage and update files for credentialing applications and re-credentialing processes. You will coordinate with medical staff, licensing agencies, and insurance carriers to ensure QA compliance.

The role supports provider credentials, maintains license/DEA/NPI records, and handles IPAs communications while adhering to privacy and deadline requirements; occasional travel is required.

Qualifications

• AA Degree or higher required; experience may substitute for education.
• 1-2 years of healthcare administrative support experience.
• Familiar with Managed Care Programs and Credentialing processes.
• Strong communication and teamwork, bilingual preferred.

Responsibilities

• Facilitate initial credentialing, ongoing monitoring and re-credentialing.
• Maintain and update provider credentialing database with licenses, DEA, NPI, diplomas.
• Coordinate with IPAs, clinics, and insurance to ensure QA compliance.
• Prepare and submit verification letters and forms to health plans.
• Provide status reports and serve as point of contact for IPAs.

Skills

Excellent Communication Skills

Excellent Customer Service Skills

Bi-lingual Spanish/English

Team player

Independent worker

Reliable transportation

Travel ability 10% outside local area

Education

AA Degree or higher

Tools

Microsoft Office

Word

Excel

Outlook

Job description

Position Summary

Manage, maintain and update files for all credentialing applications. Responsible for processing credentialing and re-credentialing applications accurately and in a timely manner. Coordinate with medical office staff, licensing/regulatory agencies, and insurance carriers to ensure Quality Assurance compliance.

Description

Position Summary

Manage, maintain and update files for all credentialing applications. Responsible for processing credentialing and re-credentialing applications accurately and in a timely manner. Coordinate with medical office staff, licensing/regulatory agencies, and insurance carriers to ensure Quality Assurance compliance.

Schedule

• Flexible, may require some evening and weekends

Primary Duties And Responsibilities

• Facilitate initial credentialing, on-going monitoring and re-credentialing process of all Providers in accordance with the National Committee for Quality Assurance standards.
• Maintain and update database for provider credentialing, including applications and all other related documents, such as California Medical license, DEA registration, NPI number, Medical School Diploma.
• Communicates with internal departments to assess addition and removal of providers onto NECC malpractice insurance; process renewal of malpractice insurance on a yearly basis.
• Complete California Participating Physician Application for all new providers and submit to IPA/Health Plans Credentialing Committee for approval; provide IPA/Health Plans with any additional Provider data, as requested.
• Serve as point of contact for IPAs; responsible for advising IPAs of all Provider changes and/or updates, including: demographic changes, clinic assignments, new Providers and release of existing Providers.
• Update IPAs of all Providers’ renewed licenses (Medical licenses, DEA registration, etc.).
• Process Hospital Privileges Application for providers, as advised by Operations Director.
• Responsible for completing all Health Plan/IPA and questionnaires.
• Prepare and submit verification letters.
• Provide status reports as requested.
• Handle confidential information in an appropriate manner.
• Attend meetings and seminars, as necessary.
• Maintain a positive working relationship with staff.
• Serves as the Licensing/Certifications Department back up.
• Other duties as designated by Operations Director or Executive Director

Qualifications

Minimum Requirements

• Microsoft Office/Word/Excel/Outlook
• Excellent Communication Skills
• Excellent Customer Service Skills
• Bi-lingual Spanish/English (preferred)
• Ability to work as a team player and work independently
• Reliable transportation
• Must be able to travel from facility to facility
• This position requires 10 % travel outside the local area.

Required Education/Experience And/or Licensure/Certifications

• AA Degree or higher, experience may substitute for education
• 1-2 year minimum experience in healthcare administrative support
• Familiar with Managed Care Programs and Knowledge of Credentialing Process
• Commitment to goals and philosophy of Northeast Community Clinic
• Valid State Identification

Physical Requirements And Working Conditions

• OSHA Category 3 – Involves no regular exposure to blood, body fluids, or tissues, and tasks that involve exposure to blood, body fluids, or tissues are not a condition of employment.
• The work is majority of the time sedentary in nature.
• The employee is regularly required to communicate, frequently required to use repetitive motions, move, remain stationary, regularly push, pull and lift up to 20 pounds and occasionally push, pull and lift up to 40 pounds.
• Must possess mobility to work in a standard office/clinic setting (in some cases both settings) and to use standard office/clinic equipment, including a computer, stamina to maintain attention to detail despite interruptions, read printed materials and use a computer, and communicate in person and over the telephone.