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Credentialing Coordinator

3 months ago

Long Beach, United States SCAN Health Plan Full time

SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation’s leading not-for-profit Medicare Advantage plans, serving more than 270,000 members in California, Arizona, Nevada, Texas and New Mexico. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 40 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. The Job Supports and facilitates the delegated reporting requirements by collecting, tracking, and reviewing CMS required submissions, including assistance with administrative tasks pertaining to practitioner credentialing. The Network Compliance Coordinator will assist with credentialing and will organize, maintain, and verify all aspects of the process, maintain current files on practitioners and track expiration of certifications to maintain up-to-date files. Develops and maintains a good working relationship with the providers and groups. Availability to serve as a source of guidance and experience, including answering questions, providing examples of compliant methodology for superior job performance. Champions compliance with official corporate audit policies and procedures. Serve as a resource and assist with escalated issues and tasks, as needed. You Will Assist Network Compliance Auditors with processing initial credentialing and re-credentialing applications, screening practitioners' applications and supporting documentation to ascertain eligibility, collecting information from the National Practitioner Data Bank (NPBD), the applicant and other relevant sources, identifying discrepancies in information and conducting follow-ups, presenting applications to the Credentialing Committee, assisting and responding to credentialing inquiries, capturing primary source documentation in computer databases and ensuring compliance with applicable laws, regulations, procedures, and policies. Provide education to delegated entities to ensure that they submit complete and accurate data according to CMS and National Committee for Quality Assurance (NCQA) specifications. Function as the point of contact for delegates on CMS required credentialing submissions, including sending credentialing requirements to FDRs within identified deadlines. Assist Network Compliance Credentialing Auditors with initial, annual and focus credentialing delegation audits. Issue and track Corrective Action Plans to groups that do not submit required documentation timely and accurately. Facilitate and support the entire Delegation Oversight Unit's timely collection of required delegate submissions. Collect, track, and review delegate submissions for CMS required documentation, including during such time that SCAN is engaged in a CMS Program Audit or other regulatory audits. Support the First Tier Downstream and Related Entity (FDR) Medicare Advantage Compliance program through collecting, tracking and trending attestations, and monitoring compliance within CMS requirements. Provide internal and external customer service following SCAN Service Principles. Utilize department documentation including policies and procedures, desktop policies and job aids, work plans, staff education materials and other documents to ensure improved efficiency, productivity and outcomes. Maintain the provider networks, customer's and member's rights to privacy and protect SCAN operations by keeping information confidential. Adhere to all quality, compliance, and regulatory standards to achieve Network Management and SCAN outcomes. Contribute to team efforts by accomplishing related results as needed. Actively support the achievement of SCAN's Vision and Goals. Your Qualifications Required: Associate's Degree or equivalent experience required. 3+ years of experience in a Healthcare or managed care environment required. Proficiency with data entry required. Ability to achieve work objectives by utilizing critical thinking skills in the decision-making process. Excellent communication skills and the ability to express ideas concisely and clearly orally and in writing. Strong organizational skills and the ability to prioritize. Strong interpersonal skills. Demonstrated customer service skills. Ability to multi-task and work with limited supervision. Ability to work well in a fast-paced and dynamic environment. Proficient in MS Office. Preferred, if applicable: Bachelor's Degree preferred. Working knowledge of Medicare and Medi-Cal guidelines, preferred. 3+ years of experience with credentialing preferred. What's in it for you? Base salary range: $23.51 to $37.60 per hour An annual employee bonus program Robust Wellness Program Generous paid-time-off (PTO) Ten paid holidays per year, plus 1 additional floating holiday Excellent 401(k) Retirement Saving Plan with employer match and contribution Robust employee recognition program An opportunity to become part of a team that makes a difference to our members and our community every day We're always looking for talented people to join our team Qualified applicants are encouraged to apply now At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more. SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required. #LI-CS2 Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities #J-18808-Ljbffr