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Credentialing Specialist

2 months ago

Garden Grove, California, United States Titanium Healthcare Full time
Job Title: Credentialing, Contracting, Job Summary

Titanium Healthcare is seeking a skilled Credentialing, Contracting, professional to join our team. As a key member of our organization, you will be responsible for maintaining strong relationships with health plans, medical groups, and other third-party payors, as well as processing all aspects of credentialing for healthcare providers within the organization.

Key Responsibilities
  • Maintain compliance with all regulatory requirements and accreditation standards
  • Collect, review, and verify provider credentials, including licenses, certifications, education, and work history
  • Maintain contract-related information in an electronic format
  • Coordinate with insurance payers to complete provider enrollment applications
  • Conduct primary source verification of credentials through various databases and organizations
  • Maintain accurate and up-to-date provider files and databases
  • Coordinate with internal departments and external entities to obtain necessary documentation and information
  • Evaluate that applications are properly verified and uploaded into the online credentialing database
  • Work with manager to prepare credentialing and re-credentialing files for accreditation surveys
  • Monitor expiring credentials and initiate the recredentialing process in a timely manner
  • Provide audit reports and conducting analysis including trend identification, and opportunities for improvement to provide individual and department level performance improvement plan
  • Ensure data is accurate, consistent, complete, and valid according to established standards
  • Respond to inquiries from providers regarding credentialing status
  • Maintain current knowledge of credentialing and auditing trends
  • Ensure maximum confidentiality, accuracy, security, and appropriate access of all data and records provides maximum protection from discoverability of all information
Requirements
  • Minimum 2 years of experience in credentialing, contracting, and enrollment within a managed care setting
  • Knowledge of credentialing standards, regulations, and best practices
  • Knowledge in contract evaluation
  • Knowledge in enrollment processes
  • Familiarity with credentialing software systems
What We Offer
  • Make an impact: an organization who cares about its employees, communities, and the future of healthcare
  • Inclusivity: be a part of a workplace where you not only belong but also can be the best version of yourself
  • Growth: opportunities to develop and grow your career with us
  • Community: you are encouraged to have a voice, share your opinions, and have individual impact on the business
  • Paid Time Off: 12 holidays and up to 3 weeks of accrued PTO to rest and recharge plus additional time for sick, jury duty, bereavement, and reproductive loss
  • Work Life Balance: enjoy flexibility to maximize your well-being and success with our hybrid work model
  • Medical, Dental, & Vision Benefits: we cover up to 100% of your premium and 50% of your dependents depending on the plan
  • Flexible Spending, Health Savings & Dependent Care Accounts
  • Life/AD&D insurance funded 100% by Titanium Healthcare
  • Supplemental Short-Term Disability
  • Employee Assistance Programs
  • 401(k) plan
EEO Statement

Titanium Healthcare is an equal opportunity employer. We are committed to promoting and celebrating all backgrounds and encourage all applicants, regardless of race, religion, gender, sexual orientation, disability, age, marital status, parental status, military or veteran status, or any other legally protected status, to apply. We believe that diversity and inclusion drive innovation and equity in healthcare, enabling us to better serve our communities and make a lasting impact.