Provider Onboarding and Credentialing Specialist

Independent Practice Management; California; On-site; USD 60,000 - 86,000; Full time

Job summary

Pulmonary Medicine Associates (PMA) in the greater Sacramento area is hiring a Full-time Credentialing Specialist. You will manage credentialing and re-credentialing for PMA providers, gather documents, and submit applications to insurers and hospitals to ensure timely processing.

The role requires strong organization, MS Office proficiency, and excellent communication with providers and staff. Experience with CAQH, PECOS, and PAVE is preferred.

Qualifications

• High school diploma or GED. Associates degree in a related field OR a minimum of 2+ years of related work in a medical environment.
• Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) a plus.
• Experience with PAVE, PECOS CAQH required.
• Must be highly organized.
• Excellent phone etiquette and verbal communication skills.
• Strong customer service skills and ability to establish and maintain effective working relationships with other employees, hospitals, insurance companies, etc.
• Excellent detail orientation and ability to maintain accurate records.
• Ability to maintain confidentiality of sensitive information.
• Ability to work independently and juggle multiple priorities.
• Good working knowledge of MS Office (Word and Excel). Must be able to accurately type 45 WPM.

Responsibilities

• Processes credentialing and re-credentialing applications of PMA health care providers.
• Coordinates with providers to gather information, such as licensing, CV, peer references, privileges lists/procedures history.
• Performs data entry.
• Prepares and submits applications for insurances, hospitals and malpractice insurance.
• Communicates regularly with applicants, providers and medical office staff to ensure credentialing is timely and completed efficiently.
• Acts as PMA liaison to hospitals and insurance companies and interprets, explains and follows all institution-specific rules, regulations and polices related to credentialing process.
• Prepares related records and reports.
• Performs other related duties as required or requested.

Skills

Organizational skills

Phone etiquette and verbal skills

Customer service

Attention to detail

Confidentiality

Independent work

Typing 45 WPM

Education

Associates degree or 2+ years healthcare experience

High school diploma or GED

Tools

MS Office (Word and Excel)

PAVE

PECOS

CAQH

Job description

Description

Pulmonary Medicine Associates (PMA) has been treating patients in the greater Sacramento area since 1973 and is a unique and exciting place to work. With specialties that include critical care, infectious disease, palliative care, pulmonology, pediatric pulmonology, and sleep medicine. We are a busy practice with over 80 providers that serves multiple hospitals and has 2 outpatient clinic locations. PMA currently has a Full-time Credentialing Specialist position available. PMA is an equal opportunity employer. PMA is an equal opportunity employer.

General Duties Include

• Processes credentialing and re-credentialing applications of PMA health care providers.
• Coordinates with providers to gather information, such as licensing, CV, peer references, privileges lists/procedures history,
• Performs data entry.
• Prepares and submits applications for insurances, hospitals and malpractice insurance.
• Communicates regularly with applicants, providers and medical office staff to ensure credentialing is timely and completed as efficiently as possible.
• Acts as PMA liaison to hospitals and insurance companies and interprets, explains and follows all institution-specific rules, regulations and polices related to credentialing process.
• Prepares related records and reports.
• Performs other related duties as required or requested.

Requirements

• High school diploma or GED. Associates degree in a related field OR a minimum of 2+ years of related work experience in a medical environment.
• Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM a plus).
• Experience with PAVE, PECOS CAQH required.
• Must be highly organized.
• Excellent phone etiquette and verbal communication skills.
• Strong customer service skills and ability to establish and maintain effective working relationships with other employees, hospitals, insurance companies, etc.
• Excellent detail orientation and ability to maintain accurate records.
• Ability to maintain confidentiality of sensitive information.
• Ability to work independently and juggle multiple priorities.
• Good working knowledge of MS Office (Word and Excel). Must be able to accurately type 45 WPM.

Physical Requirements/Working Conditions: Must be able to work in a climate controlled, office environment. Sit for extended periods of time. Ability to read and write in order to process paperwork. Manual dexterity needed for keyboarding and other repetitive office tasks. Vision must be good or corrected to normal to perform normal job duties. Hearing must be good to have the ability to understand information to perform job duties.