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Credentialing Specialist
2 months ago
We are recruiting for a Credentialing Specialist to support a busy healthcare organization in their corporate office in Sacramento. This is an onsite contract to hire opportunity with a progressive organization who specializes in connecting people with support resources and access to healthcare. The Credentialing Associate maintains information in provider credentialing files, coordinates, and monitors the re-credential process and ensures compliance with statues and laws relating to credentialing. Pay: $24-$29/hour DOE.
The ideal candidate will have two years of medical administrative experience verifying provider credentials, accurate and heavy data entry experience and working knowledge of Medi-Cal insurance.
RESPONSIBILITIES:
- Gather credentials and re-credentialing materials for contracted providers.
- Review and analyze practitioner applications and reapplications, and accompanying documents, ensuring practitioner eligibility.
- Identify issues that require additional investigation and evaluation, validate discrepancies, and ensure appropriate follow up.
- Prepare credentials file for completion and presentation.
- Respond to inquiries from other healthcare organizations.
- Assist with managed care delegated credentialing audits; conduct internal file audits.
- Monitor the initial process for all Medical/Professional staff and delegated providers.
- Ensure compliance with rules, regulations, policies, procedures, and delegated contracts.
- Perform related duties as assigned.
- High School Diploma or GED required. A college degree in a related field is preferred.
- 2+ years' experience with medical administration required.
- Experience with verifying credentials and processing new applications preferred.
- High volume data entry experience is required.
- IntelliSoft system experience preferred.
- Experience with Medi-Cal preferred.
- Strong attention to detail, focused and able to work in a fast-paced environment.
- Excellent communication skills, both verbal and written.
- Ability to solve mid-level problems with minimal supervision.
- Ability to demonstrate professionalism, confidence, and sincerity while quickly and positively engaging providers.
- Proficiency with Microsoft Office (Word, Excel, PowerPoint).
- Ability to maintain strict confidentiality.
Meet Your Recruiter
Karleen Rocheleau
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