Credentialing Specialist

1 week ago


Los Angeles, California, United States MedPOINT Management Full time
Job Summary

We are seeking a highly skilled Credentialing Coordinator to join our team at MedPOINT Management. The successful candidate will be responsible for coordinating, monitoring, and maintaining the credentialing and re-credentialing process for our providers.

Key Responsibilities
  • Collaborate with CVO, credentialing staff, and provider services to ensure accurate and timely credentialing and re-credentialing.
  • Monitor and maintain the credentialing database system and related systems to ensure compliance with accrediting and regulatory agencies.
  • Develop and maintain a working knowledge of statutes and laws relating to credentialing.
  • Prepare files for monthly credentialing committee and health plan audits.
  • Respond to inquiries from health plans and provider offices/clinics.
  • Optimize efficiency with document generation and reporting.
  • Monitor the initial, recredentialing, and expirable process for all delegated providers.
  • Handle pre-audit and preparation functions for health plan audits.
  • Enter primary source documentation in the credentialing database.
Requirements
  • High school diploma or GED.
  • At least 2 years' experience with hospital medical staff or managed care credentialing.
  • NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS) or actively pursuing the above certification highly preferred.
Skills and Abilities
  • Strong written and oral communication skills.
  • Knowledge of medical credentialing and privileging procedures and standards.
  • Ability to analyze, interpret, and prepare reports.
  • Proficiency with Microsoft Office Programs; primarily Word and Excel 2013 or higher.


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