Credentialing Coordinator

2 days ago


Los Angeles, United States MedPOINT Management Full time
Job DescriptionJob Description

Responsible for collaborating with CVO, credentialing staff and provider services to coordinate, monitor and maintain the credentialing and re-credentialing process. Responsible for the accuracy and integrity of the credentialing database system and related systems.  Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to credentialing. Prepares files for monthly credentialing committee and health plan audits. Works under the supervision of the VP, Quality Management and Manager, Compliance.

Duties and Responsibilities

1.       Leads, coordinates and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.

2.       Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.

3.       Prepares credentials files for completion and presentation to MedPOINT’s Credentialing Committee.

4.       Responds to inquiries from health plans and provider offices/clinics; interfaces with internal and external customers on day-to-day credentialing issues as they arise.

5.       Optimizes efficiency with document generation and reporting

6.       Monitors the initial, recredentialing and expirable process for all delegated providers including allied health professional staff

7.       Handles pre-audit and preparation functions for health plan audits

8.       Enters primary source documentation in home grown credentialing database

9.       Performs miscellaneous job-related duties as assigned and requested

Minimum Job 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.

Skill 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

·         EZ-CAP® knowledge a plus.



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