Credentialing Specialist

7 days ago


Beverly Hills, California, United States Global IT Resources Full time $60,000 - $120,000 per year

13 week contract

Required:

  • HSD/GED
  • Flu vaccination (no declinations/no exemptions)
  • Experience with physician insurance compliance/data integrity
  • Proficiency (Expertise) with Excel
  • Understand of HMO and Fee For Service business lines

Preferred:

  • Bachelors Degree
  • Experience with Epic Tapestry

Primary Duties and Responsibilities

  • Reviews Provider Information Forms (PIFs) related to the MDN's managed care business operations (provider networks, HMO referrals, claims, contracts)
  • Maintains the MDN's all downstream provider contract grids
  • Responsible for communicating changes to downstream provider agreements to our current third party MSO
  • Assists Manager in resolving discrepancies in provider contract records within EPIC's Tapestry Module and associated HMO referral system(s);
  • Maintains internal rosters to mitigate inadvertent leakage resulting from incorrect listings
  • Provides paneling information provided to Health Plans is accurate and timely to support Senate bill AB137
  • Conducts routine audits of provider updates
  • Assists with the implementation of new or amended ancillary and provider contracts.
  • Works with Contracting team to determine financial implication of identified discrepancies
  • Periodically audit payor reports and provider listings to ensure accurate and complete participation of MNS-represented physician networks.

Job Types: Full-time, Contract

Pay: $ $29.00 per hour

Expected hours: 40 per week

Benefits:

  • 401(k)
  • Dental insurance
  • Health insurance
  • Vision insurance

Work Location: In person



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