Provider Credentialing Coordinator

1 week ago

Laguna Hills, California, United States AmeriPharma Full time
Job Overview

Salary: $23-$26 Hourly DOE

About AmeriPharma

AmeriPharma is a dynamic healthcare organization dedicated to fostering innovation and collaboration. We appreciate individuals who bring creativity and enthusiasm to their roles, contributing to our collective success.

Benefits Offered by AmeriPharma

  • Comprehensive benefits package including medical, dental, vision, and life insurance tailored to your needs
  • Competitive salary and compensation structures
  • Employee assistance program for mental health, legal inquiries, and financial advice
  • Generous paid time off and sick leave policies
  • 401k retirement plan
  • Numerous opportunities for professional growth and advancement
  • Company-sponsored events and team-building activities
  • Casual work environment on designated days

Position Summary

Under the supervision of the Quality Compliance Manager, the Provider Credentialing Coordinator plays a vital role in ensuring that healthcare providers are credentialed, contracted, and active with payers efficiently. This role acts as a bridge between various departments and external partners to ensure effective communication and adherence to organizational standards. A solid understanding of payer-provider dynamics, contracting, provider enrollment, and credentialing is essential.

Key Responsibilities

  • Assist in collecting and managing all necessary documentation for contracting, enrollment, and credentialing, ensuring that all information is complete to meet external requests within deadlines.
  • Support the Specialists in reviewing and managing contracts with payers.
  • Organize and maintain payer agreement provisions within the company’s database.
  • Update and store payer educational materials in shared resources.
  • Monitor compliance with contractual obligations and regulations set by payers.
  • Keep the team informed about changes in the healthcare landscape, payer policies, and regulations.
  • Ensure that pharmacy information is accurate and updated in a timely manner.
  • Collaborate with team members to achieve departmental goals and assist in various responsibilities.
  • Utilize online systems, written communication, and phone inquiries for follow-ups.
  • Assist Specialists in resolving issues that may arise during the credentialing process.
  • Support additional duties that align with the company’s core values.

Qualifications

  • Strong verbal and written communication skills.
  • Exceptional interpersonal and customer service abilities.
  • Outstanding organizational skills with a keen attention to detail.
  • Able to thrive in a fast-paced and sometimes high-pressure environment.
  • Team-oriented with the ability to support multiple roles.
  • Proficient in Google Suite and Microsoft Office Suite.

Education and Experience

  • High school diploma or equivalent required.
  • A minimum of two years of experience in credentialing or enrollment within a healthcare environment.
  • Familiarity with credentialing processes and procedures across various states and regions.
  • Knowledge of PAVE (Provider Application and Validation for Enrollment) and PECOS (Provider Enrollment Chain and Ownership System).
  • Understanding of state, federal, and accreditation regulations related to payer credentialing.

AmeriPharma's Commitment

Our mission is to achieve exceptional clinical and economic outcomes while providing compassionate care to our patients. We believe it is our shared responsibility to demonstrate our commitment to patients, prescribers, colleagues, and the community.

Physical Demands

The physical requirements outlined here are representative of those that must be met by an employee to successfully perform the essential functions of this role. Reasonable accommodations may be made to enable individuals with disabilities to perform these functions. The employee is regularly required to sit and communicate effectively. Occasionally, the employee may need to stand, walk, or reach for objects. The employee must be able to lift and/or move up to 20 pounds frequently and occasionally lift or move up to 30 pounds. Specific vision abilities required include close vision and the ability to adjust focus.

Diversity and Inclusion

AmeriPharma values diversity in its workforce and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, sex, color, religion, sexual orientation, gender identity, national origin, age, protected veteran status, or disability.

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