CREDENTIALING SPECIALIST

Responsibilities

Come and join the RMC Family

We have been in the community since 1935. Our mission is to provide comprehensive multi-specialty medical services in the greater Riverside region. Your passion, inspiration, and talents are invaluable to us and our mission to serve others. Our facility can provide a place for you to thrive and continue your professional development. Quality Healthcare is our passion, improving lives is our reward. We are working to change lives and transform the delivery of healthcare.

Riverside Medical Clinic is the best place to work, practice medicine, and receive care.

SUMMARY: The Credentialing Specialist provides administrative and functional assistance to the Medical Staff/Credentialing Department. Responsibilities include providing initial contact and assistance to visitors, physicians and employees that come into the office, first line telephone answering, replying to physician reference letters, preparing Board letters and correspondence opening and appropriate distribution of departmental mail, ordering and maintaining departmental supplies, maintaining files and minutes manuals for ready access of information in accordance with established procedures, and other duties as assigned by the department supervisor.

QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential function satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.

HOURS: Monday- Friday 8:30AM- 5:30PM

Qualifications

EDUCATION / EXPERIENCE: High School Diploma or GED required. Knowledge of Microsoft Office (Word, Access, and Excel) required. Experience with Internet Access & Searches. One (1) year of credentialing experience preferred.

CERTIFICATES, LICENSES, AND REGISTRATIONS: None.

ESSENTIAL FUNCTIONS: Essential functions are those tasks, duties and responsibilities that comprise the means of accomplishing the job's purpose and objectives. Essential functions are critical or fundamental to the performance of the job. They are the major functions for which the person in the job is held accountable. Note: (other duties may be assigned, deleted or changed at any time, at the discretion of management, formally, or informally, either verbally or in writing).

1. Prepare health plan applications and enrollment submissions to all RMC contracted health plans, including Medicare and Railroad Medicare for (re)assignment of benefits (as appropriate).

2. Maintain open communication with the health plans. Responsibility for maintaining RMC Physician directories, including health plan notifications of additions/terminations of providers.

3. Assist with reviewing and verifying all credentialing documentation for providers, confirming consistency and accuracy based on regulatory requirements.

4. Assist with scheduling, coordinating, and preparing for credentialing committee meetings including but not limited to: booking meeting rooms, sending out meeting requests, preparing documents, and assembling binders.

5. Assist with coordinating with various departments including Risk Management and Quality Improvement for report preparation for credentialing committee.

6. Assist Supervisor with credentialing audits on an as needed basis.

7. Maintain accuracy and integrity of the credentialing database as well as ensure all credentialing files are organized, neat, and current.

8. Maintain provider credentialing files to ensure accuracy and efficiency throughout the credentialing process.

9. Responsible for monthly network provider licensing expirables, renewals, and updates, including sending notifications to providers requesting current, updated copies of expirables (i.e. Medical Licenses, DEA, Liability Insurance, and other licenses/certification (if applicable).

10. Responsible for ongoing monitoring, semi-annual, and quarterly reports.

11. Prepares and sends appropriate documentation for licensing and certification renewals, and credentialing verification fees and payments, to internal and external customers as necessary.

12. Works with internal and external customers on day-to-day payor credentialing and requests as they arise.

13. Perform any additional duties as requested by management within the scope of knowledge.

This opportunity offers the following:

Challenging and rewarding work environment
Growth and Development Opportunities within UHS and its Subsidiaries
Competitive Compensation

About Universal Health Services

One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World's Most Admired Companies by Fortune; and listed in Forbes ranking of America's Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.

Avoid and Report Recruitment Scams

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.

If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.

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