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Credentialing Coordinator

2 months ago

Pasadena, United States New Leaf Staffing, Inc. Full time
Position: Credentialing Coordinator
Location: Pasadena, CA
Temp with possibility for perm
Monday - Friday 8:30 am - 5:00 pm

JOB SUMMARY:
Responsible for the timely gathering, reviewing, and compiling of provider application information to be submitted to the appropriate credentialing service party. Ensures interpretation and compliance with the appropriate credentialing regulations. Responsible for the accuracy and integrity of the CAQH and credentialing tracking databases. Acts as the liaison between the credentialing services and providers/health plans.

ESSENTIAL JOB FUNCTIONS:
  • Completes credentialing, re-credentialing and medical staff applications for clinical staff and submits information to commercial and government payors in a timely manner.
  • Ensures that all provider files are complete with current licensing and certification documents.
  • When appropriate, works cooperatively with administrative staff to obtain pertinent information necessary for IPA's.
  • Develops thorough understanding of credentialing terminology and documents and is able to utilize external systems used to research and obtain pertinent information.
  • Manages provider profiles in practice management system.
  • Manages IPA coordination for information, and ensures providers are maximized.
  • Responsible for the timely gathering and submitting for processing to IPA's and health plans on an ongoing basis, all credentialing and re-appointment applications.
  • Assist provider on completing credentialing application when necessary.
  • Tracks all pending applications and notifies the supervisor of any challenges with obtaining provider information.
  • Responsible for reviewing and verifying all credentialing documentation for providers, confirming consistency and accuracy based on regulatory requirements.
  • Coordinates review and approval of clean files by the Medical Director.
  • Prepares credentialing documentation for Risk Management and Compliance Committee.

EDUCATION/EXPERIENCE:
  • High school graduate or equivalent.
  • 2 years credentialing experience or equivalent education and experience.
  • Proficient in the use of Microsoft Office: Word, and Excel
  • Willingness and ability to read, write, speak, understand English and have the communications skills necessary to provide accurate information to residents and staff.
  • Willingness and ability to follow written and verbal direction in English.