Community Clinic Credentialing Coordinator

2 months ago

Los Angeles, United States Kheir Clinic (FQHC) Full time $19 - $25
The Credentialing Coordinator will be an active member of the Compliance and Credentialing teams, which includes the HR & Compliance Director, Compliance Coordinator and selected clinic staff. Will be responsible for maintaining current knowledge of relevant compliance requirements, clinic operations and managed care programs. Must be highly proficient in Microsoft Office programs and other computer functions in order to maintain detailed records.

MINIMUM QUALIFICATIONS:
  • Bachelor's degree in healthcare administration, public health, or a related field.
  • Minimum of 2 years of experience in healthcare compliance or a related field.
  • Strong knowledge of healthcare laws and regulations, including HIPAA, OSHA, HRSA, FTCA.
  • Excellent organizational skills and attention to detail.
  • Strong communication and interpersonal skills.
  • Strong ability to research and resolve compliance issues.
  • Strong knowledge of the health care managed care compliance requirements.
  • Ability to work independently and as part of a team.
  • Excellent written and verbal communication skills.
  • Excellent time management and organizational skills.
  • Excellent computer skills, including email, Microsoft Office (Excel) & data tracking.
  • Ability to work quickly, follow directions and make independent decisions.
  • Ability to maintain confidentiality when handling patient medical records.
  • Experience in community clinic environment a plus.
  • Valid California driver license and insurable driving record required.

ESSENTIAL FUNCTIONS/RESPONSIBILITIES:
  • Collect, review and verify credentials of healthcare providers, including licenses, certifications, education, training and work experience.
  • Conduct primary source verification of credentials in accordance with organizational policies and regulatory standards.
  • Maintain internal provider grid to ensure all information is accurate.
  • Ensure enrollment in Medi-Cal, Medicare, National Plan and Provider Enumeration System, Provider Enrollment Chain and Ownership System, Provider Application and Validation for Enrollment, CAQH ProView, etc.
  • Complete revalidation requests issues by government payers.
  • Maintain accurate and up-do-date records in credentialing databases.
  • Coordinate Provider Credentialing and Re-Credentialing with Health Plans to meet all HRSA and state regulatory agency requirements.
  • Serve as point of contact for providers regarding credentialing inquiries and issues.
  • Communicate credentialing requirements and processes effectively to new and existing staff.
  • Assist in training and onboarding of new credentialing staff as needed.
  • Provide support in the development and implementation of credentialing policies and procedures.
  • Support credentialing process improvement and efficiency initiatives.
  • Assist with the development and maintenance of policies and procedures related to compliance with federal, state, and local regulations.
  • Conduct regular audits to assess compliance with healthcare laws, regulatory standards, and internal policies.
  • Assist with staff training on compliance requirements and best practices.
  • Keep abreast of changes in healthcare regulations, ensuring compliance.
  • Monitor and track compliance indicators to ensure the clinic's adherence to standards.
  • Garner & maintain knowledge of Health Plan compliance requirements, medical group operations, and medical terminology.
  • Work with the training and development staff to deliver and update training documentation, ensuring comprehensive understanding and adherence to compliance protocols.
  • Develop and conduct trainings relating to emergency management and risk management.
  • Provide support in relation to Risk Management requirements.
  • Assist preparing for and participating in audits and regulatory reviews.
  • Assist with Survey Requests.
  • Support various compliance initiatives as needed.
  • Other duties as assigned & necessary.

Benefits:
  • 401(k).
  • 401(k) matching.
  • Dental insurance.
  • Health insurance.
  • Paid time off.
  • Professional development assistance.
  • Referral program.
  • Vision insurance.


About Kheir Clinic (FQHC):

The Kheir Clinic is a primary provider of critical in-language healthcare and human services support to the residents of Metro Los Angeles and its neighboring communities. We strive to accommodate underserved residents in the greater Los Angeles area regardless of race, ethnicity, gender, sexual orientation or income.

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