Contract & Credentialing Specialist II

1 month ago

Truckee, United States Tahoe Forest Health Full time
This position is expected to sit in Truckee, CA and is not remote.

Bargaining Unit: Non Represented - Professional

Rate of Pay: $34.46/hour + DOE

Summary
Provides administrative and clerical support for managed care activities for the District. Performs a variety of tasks related to the oversight, development and support of all contract coordination activities for the District including but not limited to credentialing, re-credentialing, analysis, communication, process development and maintenance of managed care contracts, rosters and enrollments. . In addition, provides administrative services to support the payer credentialing/privileging process for all Multispecialty clinicians.

Essential Duties and Responsibilities

  • Coordinates and assists in maintaining the District's health contracts.
  • Provides an annual audit of contract terms and conditions for CFO
  • Tracks new contracts through the review and approval process.
  • Provides re-credentialing support services for hospital. Coordinates review and re-filing of applications with Business Office and Access Center Directors, and Chief Financial Officer.
  • Conducts an annual update with the health plans to update services and provider exhibits.
  • Monitors health plan rosters to assure correct listings of hospital, MSC, and providers on health plan websites.
  • Develops and maintains relationships with all managed care plans with which the District contracts. Assists in the resolution of problems with contracted payers directed by the CFO.
  • Maintains current copies and information regarding MSC clinics licensure and clinical accreditation, with local and state agencies.
  • Completes and maintains applications and other documents related to MSC credentialing and governmental agencies.
  • Provides credentialing support services for new providers during Onboarding, office procurement and implementation.
  • Provides re-credentialing support services for existing providers, gathers information such as DEA, malpractice policies, etc. for the benefit of MSC, the District and health plans. Able to work effectively in the Districts MD Staff database.
  • Processes credentialing/re-credentialing materials and membership applications. Tracks progress of credentialing reviews by credentialing committees and Medical Executive Committees.
  • Monitors contents of application packets to ensure completeness, researching problems that affect timely credentialing and privileging.
  • Interfaces with clinicians, Administrators, and hospital and clinic staff regarding the credentialing status of MSC and physicians.
  • Establishes and maintains database of credentialing including expirations of licenses, insurances, board certification, liability insurance etc.
  • Maintains up-to-date copies of health plan contracts.
  • Work requires the ability to prioritize workload, planning for cyclical as well as daily tasks/events, meeting deadlines, responding promptly to critical organizational issues, and managing the demands of multiple projects very frequently.
  • Demonstrates System Values in performance and behavior.
  • Complies with System policies and procedures.
  • Other duties as may be assigned.
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Supervisory Responsibilities
No supervisory responsibilities.

Minimum Education/Experience
No educational requirement and 3 or more years relevant experience

Required Licenses/Certifications
Valid Driver's License in good standing - Upon hire

Other Experience/Qualifications

Required:
  • Minimum 3-5 years of experience in medical credentialing and managed care credentialing.
  • Ability to work independently with minimal supervision.
  • Demonstrates strong customer service skills and telephone skills.

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