Overview
Duties and Responsibilities:
Health Plan Contracts:
- Develop and maintain provider credentialing files and internal electronic tracking systems.
- Review clinical provider applications for completion and accuracy, ensure timely and accurate follow-up; monitor and report on the credentialing progress of each practitioner.
- Maintain timely and accurate data entry, and periodically revise provider data in the department records; maintain provider demographic and electronic data files; use Council for Affordable Quality Healthcare (CAQH) system to submit provider data as required by health plans.
- Utilize extensive Internet and telephone communication to obtain and share information.
- Notify insurances carrier and other relevant entities of provider changes.
- Update health plan directories with accurate information about participating clinics and providers.
- Act as liaison between providers and contracted insurance plans in the areas of credentialing, provider relations, and orientations.
- General administrative tasks as needed.
Credentialing & Privileging:
- Assist with all duties related to credentialing and privileging (C&P) aligned with La Clinica C&P policy
- Utilize ECHO to maintain a current and accurate record of C&P provider data, including initial and re-credentialing
- Maintain and monitor credentialing files with all required supporting documentation
- Coordinate the credentialing process, as outlined in the agency’s policy, for all new providers, including employees, volunteers, locums, and independent contractors.
- Collaborate with the HR recruiters to monitor the recruitment status of candidates to ensure timely credentialing prior to employment
- Communicate with clinic managers to ensure the re-credentialing requirements are met and maintained
- Maintain and closely monitor clinical license, certification, and/or required regulatory registration (DEA, BLS, etc.) for all providers to ensure C&P requirements are current at all times.
- Manage the electronic tracking systems to capture and report on all credentialing requirements
Job Requirements:
- Demonstrated ability and commitment to excellent customer service to maintain and ensure effective working relationships with internal and external clients
- Excellent attention to detail and a high degree of accuracy, in a fast-paced environment
- High level of organizational skills and demonstrated ability to maintain and improve systems
- Ability to maintain confidentiality
- Demonstrated ability to perform tasks involving independent judgment
- Ability to manage multiple projects efficiently and accurately, prioritizing and managing deadlines
- Proficient in Microsoft Office (Word, Outlook, Excel) and office machines
- Able to maintain a steady pace, at times working at a fast pace to meet deadlines or when working under short notice
- Six months of administrative experience
Job Preferences:
- High School diploma
- 1-2 Years of work experience in all facets of credentialing, including to interacting with physicians and other health care providers.
- Experience in working with various databases
- Experience with medical and professional credentialing processes, policies, and procedures, including credentialing requirements
- Experience with practitioner credentialing, data collection, and record management systems
- · Experience in a community health care setting, preferably with insurance or managed care plans experience