Senior Credentialing Specialist
2 weeks ago
Title: Sr. Credentialing Coordinator
Location: Fountain Valley, CA / Hybrid
Department: Quality Assurance
Status: Full-Time
Shift: Days (8hr)
Pay Range*: $25.71/hr - $37.28/hr
MemorialCare is a nonprofit integrated health system that encompasses four prominent hospitals, award-winning medical groups with over 200 care sites, and a network of more than 2,000 physicians throughout Orange and Los Angeles Counties. Our commitment lies in enhancing access to patient-centered, affordable, and high-quality healthcare; your contributions are vital to MemorialCare's standing as a leader and innovator in value-based care models.
Within our network of medical centers, we empower each of our talented employees to achieve the highest levels of professional growth, contribution, collaboration, and accountability. Regardless of your role or expertise, we are dedicated to supporting you in realizing your full potential in an environment characterized by respect, innovation, and teamwork.
Position Summary
The Senior Credentialing Coordinator plays a crucial role in managing and maintaining the credentialing workflow. Collaborating with the Credentialing Manager, Department Director, and Chief Medical Officer (CMO), this position oversees all credentialing functions for MemorialCare Select Health Plan (MCSHP). Responsibilities include the timely and precise processing of applications and related documents to comply with regulatory and plan requirements, working with the Credentialing Verification Office (CVO) for primary source verification and file review, identifying missing information, and compiling necessary documentation. Additionally, this role involves preparing for meetings and assisting in presenting provider files to the Credentialing Committee.
The Senior Credentialing Coordinator also supports credentialing staff with existing processes and initiatives for process enhancement. This position is responsible for compiling and analyzing reports related to departmental and CVO metrics, productivity, and compliance. Furthermore, the Senior Credentialing Coordinator ensures the accuracy and integrity of the credentialing database.
Essential Functions and Responsibilities of the Job
- LANGUAGE SKILLS : Proficient in reading and interpreting documents such as safety regulations, operational and maintenance instructions, and procedural manuals. Capable of writing routine reports and correspondence. Effective in speaking before groups of customers or employees.
- REASONING ABILITY : Able to apply common sense to execute detailed but straightforward written or oral instructions. Competent in addressing problems involving a few concrete variables in standardized situations.
- OTHER SKILLS and ABILITIES : Proficient in Microsoft Word, Excel, Outlook, and PowerPoint. Strong oral and written communication skills along with research and problem-solving abilities. Attention to detail and accuracy is essential. Ability to meet deadlines and maintain excellent interpersonal skills focused on internal and external customer satisfaction and teamwork. Proven commitment to quality, collaboration, customer service, and professionalism.
- Meet or exceed productivity and quality standards as assigned by management.
- Take responsibility for various projects as assigned by management and perform any additional duties as requested by the management team within the scope of knowledge and ability.
- Display leadership qualities, work collaboratively as a team player, and communicate positively with colleagues, managers, providers, and other contacts.
- Maintain a high level of confidentiality regarding provider credentials, peer review, and provider status.
- Ability to interact positively and constructively.
- Ability to prioritize tasks and manage multiple responsibilities.
Qualifications
Minimum Requirements
Qualifications/Work Experience:
- Minimum of five years' experience in healthcare with at least three years of credentialing experience required.
- Familiarity with various healthcare industry regulatory agencies and requirements, including but not limited to CMS, NCQA, DMHC, ICE, DHCS, preferred.
- ECHO experience is strongly preferred.
- Proficiency in Microsoft Office applications including Word, PowerPoint, Excel, and Outlook is essential.
- Associate's degree (A.A. or A.S) from a two-year college or technical school is required.
- Bachelor's degree (B.A. or B.S) is preferred.
- Certified Provider Credentialing Specialist (CPCS) is preferred.
- Certified Professional in Medical Services Management (CPMSM) is preferred.
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