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Sr. Credentialing Coordinator
2 months ago
Title: Sr. Credentialing Coordinator
Location: Fountain Valley, CA / Hybrid
Department: Quality Assurance
Status: Full-Time
Shift: Days (8hr)
Pay Range*: $23.55/hr - $34.13/hr
MemorialCare is a nonprofit integrated health system that includes four leading hospitals, award-winning medical groups - consisting of over 200 sites of care, and more than 2,000 physicians throughout Orange and Los Angeles Counties. We are committed to increasing access to patient-centric, affordable, and high-quality healthcare; your personal contributions are integral to MemorialCare's recognition as a market leader and innovator in value-based and other care models.
Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration, and accountability.Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation, and teamwork.
Position Summary
The Senior Credentialing Coordinator is responsible for processing and maintaining aspects of credentialing workflow. In collaboration with the Credentialing Manager, Department Director and Chief Medical Officer (CMO), the position oversees all credentialing activities for MemorialCare Select Health Plan (MCSHP), including but not limited to the timely and accurate processing of all applications and related documents required to meet regulatory and plan requirements for credentialing, collaboration with Credentialing Verification Office (CVO) for primary source verification and file review, identification of missing information, collection of information and file compilation. In addition, this position is responsible for meeting preparation and assisting in the presentation of provider files to the Credentialing Committee.
The Senior Credentialing Coordinator assists credentialing staff with current processes as well as process improvement. The Senior Credentialing Coordinator compiles and analyzes reports in relation to department and CVO metrics, productivity and compliance. The Senior Credentialing Coordinator is also responsible for the accuracy and integrity of the credentialing database.
Essential Functions and Responsibilities of the Job
- LANGUAGE SKILLS :Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals.Ability to write routine reports and correspondence.Ability to speak effectively before groups of customer or employees of the organization.
- REASONING ABILITY :Ability to apply commonsense understanding to carry out detailed but uninvolved written or oral instructions.Ability to deal with problems involving a few concrete variables in standardized situations.
- OTHER SKILLS and ABILITIES : Proficient on Microsoft Word, Excel, Outlook and PowerPoint. Strong oral and written communication and research/problem solving skills. Attention to detail and accuracy.Ability to meet deadlines.Excellent interpersonal skills with a focus on internal/external customer satisfaction and teamwork.Proven dedication to quality, teamwork, customer service and professionalism.
- Meet or exceed productivity and quality standards as assigned by management.
- Take responsibility for various projects as assigned by management and perform any additional/miscellaneous duties (not inclusive of job description) as requested by the management team within the scope of knowledge/ability.
- Must display leadership skills, work as a team player and communicate in a positive manner with co-workers, managers, providers, and other contacts.
- Maintain a strict degree of confidentiality in all areas relating to provider credentials, peer review and provider status.
- Ability to interact in a positive and constructive manner.
- Ability to prioritize and multitask.
Qualifications
Minimum Requirements
Qualifications/Work Experience:
- Minimum of five years' experience working in healthcare with 3 years previous credentialing experience required.
- Experience working with various healthcare industry regulatory agencies and requirements including but not limited to CMS, NCQA, DMHC, ICE, DHCS, preferred.
- ECHO experience strongly preferred.
- Proficiency in Microsoft Office applications including Word, Power Point, Excel, and Outlook is a must.
- Associates degree (A.A. or A.S) from two-year college or technical school- required.
- Bachelor's degree (B.A. or B.S)- preferred
- Certified Provider Credentialing Specialist (CPCS) -preferred
- Certified Professional in Medical Services Management (CPMSM)-preferred
