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Provider Enrollment Credentialing Specialist

2 months ago

Central, United States South Central Family Health Cent Full time

**Title**: Provider Enrollment & Credentialing Specialist

**Base Salary Range**: $51,549 - $77,024 plus benefits

**FTE**: Non-Exempt, Full Time

**Our Mission**: The Mission of South Central Family Health Center is to improve the quality of life for the diverse community of inner-city Los Angeles by providing affordable and comprehensive health care and education in a welcoming and multicultural environment. To lead the way in health care in South Los Angeles, as the premier provider and employer of choice offering comprehensive, high quality, affordable, efficient and culturally responsive services.

**General Summary**: The Provider Enrollment & Credentialing Specialist is responsible for leading, coordinating, monitoring, and maintaining the credentialing and re-credentialing process. Facilitates all aspects of SCFHC credentialing, including initial appointment, reappointment, expiration process, as well as clinical privileging for Medical Staff, Allied Health Professionals, and all other providers outlined in the SCFHC Bylaws, policies, or related contracts.
- Ensures that credentialing and re-credentialing of providers occurs on a timely basis.
- Works collaboratively with a wide range of healthcare professionals, including providers, other healthcare leaders, and fellow employees at the local and company-wide levels.
- Ensures compliance with applicable federal and/or state laws, regulations, and/or agency rules, contract standards and guidelines regarding credentialing and program enrollment.
- Oversee the collection of all pertinent primary source verification for all providers and practitioners. Run newly hired practitioners credentials across five different primary source verification databases (NPPES, OIG, NPDB, DEA, Breeze).
- Prepares credentials file for completion and presentation to the internal Credentialing Committee and Corporate Medical Committee, ensuring file completion within the time periods specified and obtains required signatures.
- Coordinates with various departments regarding audit preparation, staff training, and compliance related to credentialing.
- Coordinate with the managed care department and scheduler regarding provider panels and provider assigned locations to update provider credentialing files and the IPA.
- Provides administrative support, including answering phones, take messages, and distributing route messages accordingly.
- Process all mail and correspondence for the Medical Administration office.

**Qualifications and Certifications**:

- AA degree Required
- Bachelor’s degree preferred
- High School Diploma or equivalent required
- Current California Driver’s License and Automobile Insurance

**Top benefits or perks**: As a team member at South Central Family Health Center, you’ll enjoy competitive wages and generous benefits:

- Benefits: Health Care, Dental, Life Insurance
- 403 (b) Retirement plan
- Education Reimbursement
- Career development: Entry-level employees have opportunities to work in management, HR, or other areas of the company

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