Credentialing Specialist

2 weeks ago

Fresno, United States Sante Health Full time
Job DescriptionJob Description

A challenging and rewarding opportunity awaits a Credentialing Specialist at Sante Health System in Fresno, CA . This position is responsible for coordinating, monitoring and performing credentials verification process for initial appointments and reappointments of physicians and allied health professionals. Incumbents will be skilled in all aspects of initial comprehensive credentialing, recredentialing, performance monitoring, in accordance with NCQA accreditation standards, state and federal regulatory requirements, and Sante's credentialing policies and procedures.

QUALIFICATIONS FOR A CREDENTIALING SPECIALIST
  • Two years relevant experience in physician credentialing.
  • Excellent communication skills both written and verbal, including telephonically, email, and presentation.
  • Ability to work independently with minimal supervision.
  • Ability to establish and maintain effective working relationships with providers, management, staff and contacts outside the organization.
  • Proficient use of Microsoft Office applications. Certified Provider Credentialing Specialist (CPCS) preferred.
  • AA/AS degree preferred.
ESSENTIAL DUTIES AND RESPONSIBILITIES
  1. Verify competence, medical and/or professional education, residency, internships, fellowships, additional formal training, relevant board certifications, health care affiliations, work history, licensure and certifications, DEA certificates and malpractice coverage.
  2. Perform and collect all primary source documentation as outlined in the Policies and Procedures for initial credentialing and recredentialing for Sante Physicians IPA.
  3. Analyze physician practice/specialty parameters for Sante's business needs and prepare reports for presentation to Board of Directors and Committees for review and approval.
  4. Actively participates in all required annual audits.
  5. Keep abreast of all current credentialing/recredentialing mandated guidelines, policies and procedures in order to formulate new and revise current Sante policies and procedures.
  6. Ensures support, maintenance, and updating of the practitioner credentialing database system.
  7. Provides quality and ethical customer service to all practitioners, medical group liaisons, and other hospital/healthcare entities.
  8. Meet all Health Plan quarterly and semi-annual reporting requirements.
  9. Assist in preparing data for required Committee meetings with the ability to record and transcribe minutes of Committee meetings.
  10. Review credentialing delegation agreements as presented by current and potential contracted health plans to ensure accuracy of delegation parameters.
  11. Track adverse licensure actions with the ability to communicate directly with the practitioner (written and verbally); actively participate in QI reviews on adverse licensure issues.
  12. Orient and train new staff.
  13. Maintain confidentiality of provider information
PERFORMANCE REQUIREMENTS
  • Maintain health plan delegation for credentialing by way of successfully passing annual health plan audits.
  • Knowledge of computer program applications including MS Word/Excel/PowerPoint.
  • Knowledge of Santé Credentialing policies and procedures.
ESSENTIAL DUTIES AND RESPONSIBILITIES
  1. Skill in establishing and maintaining effective working relationships.
  2. Ability to organize workflow, effectively prioritize, and meet deadlines and objectives.
  3. Research, analyze and interpret data and present comprehensive reports.
  4. Ability to communicate clearly and effectively orally and in writing.
  5. Excellent time management, multi-tasking, and prioritization skills.
  6. Other functions and accountabilities may be assigned
ABOUT SANTE HEALTH SYSTEM

Sante Health System is a Management Services Organization that serves multiple clients. "Sante" is the French word for health. Our name symbolizes our commitment to good health, progressive care, and leadership in our community.

Sante is one of the largest health care claims and billing management companies in Central California. The strength of Sante is the extraordinary network of physicians, health plans, and other health service providers it offers the people of our valley. Sante coordinates with physicians, health plans, hospitals, and ancillary providers to ultimately benefit the patient in a managed care environment. Sante Health System provides numerous client services such as billing, claims processing, contracting, credentialing, finance, human resources, information services, marketing/communications, physician services, practice management, provider relations, quality improvement, and utilization management.

Sante is celebrating over 25 years of service to the community. We deeply understand that we would not be successful in enhancing the quality of life of our patients without our incredible team. This is why we have created a work culture that is comprised of talented, driven, dedicated, innovative, and service-driven professionals. We provide competitive pay, excellent benefits including medical, dental, vision, and life insurance, 401k retirement plan, paid time off, and opportunities for advancement. Being part of our team is like being part of a big family. Join our team and make Sante Health System your home away from home.

READY TO JOIN OUR TEAM?

We understand your time is valuable, so we have a very quick and easy application process. If you feel that you would be right for this job in health care, please fill out our initial 3-minute, mobile-friendly application. We look forward to meeting you


www.santehealth.net

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