Credentialing Specialist
4 weeks ago
**Why work for Balboa**:
- Balboa Nephrology is the largest kidney care practice in California and participates in a national Medicare program focused on value-based care.
- Through our joint venture with Evergreen Nephrology we are a growing organization with opportunities for professional and personal growth.
- We will help you grow in your leadership experiences while learning the new value-based care world.
- Comprehensive benefits package that includes medical, dental & vision on the 1st of the month 30 days after hire.
- Employer contribution of up to 10% of annual pay for your 401K.
- Generous paid time off plus 8 paid holidays, a birthday float day off and a mental health day
- Company paid life insurance.
- Join a fast-growing field - employment of medical and health services managers is projected to grow 32 percent from 2020 to 2030, much faster than the average for all occupations.
- Voted Top Workplace of San Diego 2017 and 2020 - 2023
- Hybrid position after successful completion of training.
- Eligible for department bonus after 90 days of employment.
**Our Values**: Patient-centered I Accountability I Respect I Innovation I Data-Driven
**Our Mission**:to consistently deliver superior care - Balboa Care - to every patient with kidney disease.
**Work location**: Hybrid
- Works out of Executive Square office in La Jolla, San Diego, CA. Eligible for hybrid schedule upon successful completion of training.
**Position Summary**:
The Credentialing Specialist works closely with the Credentialing Supervisor and is responsible for all aspects of credentialing and re-credentialing as it relates to provider enrollment with payors, facilities and government entities as assigned. This position ensures all providers are appropriately credentialed, which includes the responsibility of maintaining current information on file and within the credentialing database. The Specialist is responsible for timely provider updates and directory accuracy with all health plans.
**Pay Rate**:$24.00 - $29.00/hour, depending on experience
**Essential Duties and Responsibilities**:
- Maintenance of CAQH profiles and internal credentialing database and ensure up-to-date information is obtained at all times.
- Responsible for monitoring and managing credentialing/re-credentialing requirements and to ensure the collection of all required renewal certifications are on file within the required time frame.
- Provide support to providers, providers office staff, Revenue Cycle staff, health plan contacts and company departments as necessary.
- Timely updates to provider directory information on several platforms in compliance with CA Senate Bill 137.
- Supports and actively participates in process improvement initiatives.
- Assists with other duties to support the revenue cycle process and Balboa’s core values.
**Required Qualifications**:
- 2 years recent enrollment/credentialing experience in a medical group, or physician setting.
- Strong proficiency with Microsoft Windows (ability to navigate, create and rename folders, save and organize files), Strong proficiency with Microsoft Office products (Outlook, OneNote, Teams, Excel, Word), proficiency with Adobe PDF. Ability to type 30 words per minute.
**Preferred Qualifications**:
- Health plan contracting and enrollment experience.
- Experience with PAVE (Provider Application and Validation for Enrollment) & PECOS (Provider Enrollment Chain and Ownership System).
- Experience with Credential My Doc credentialing database.
**Education**:
- High School graduate required
**Required Skills**:
- Excellent verbal and written communication.
- Ability to establish and maintain effective working relationships with providers, medical staff and coworkers.
- Demonstrates accuracy, organizational and problem-solving skills. Looks for ways to improve and promote quality and monitors own work to ensure quality is met.
- Maintain confidentiality.
- Work independently, prioritize work activities and use time efficiently.
***
**Other Considerations**:
- Background check required
- Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
- Supervisory duties - no
- Status - full time
- Work Environment - This position operates in a professional office environment and routinely uses standard office equipment such as laptop, computer, mouse, and photocopier.
- Physical Demands - While performing duties, the employee is regularly required to talk, hear, read, write, type and respond. Specific vision abilities required by this job include close vision and ability to adjust focus. This position requires the ability to open cabinets at various levels, bend, stand, stoop and drive as necessary.
**Language Skills**
While performing duties, the employee is regularly required to
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