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Credentialing Specialist - Merced

Company: Golden Valley Health Centers
Location: Atwater
Posted on: May 3, 2021

Job Description:

The Credentialing Specialist provides skilled support to the GVHC credentialing processes and functions.Schedule is Monday - Friday 8:00am - 5:00pmEssential Duties and ResponsibilitiesDemonstrates effective communication and problem-solving skills.Will identify, obtain and verify credentials for all licensed practitioners for initial credentialing and re-credentialing.Compiles, creates and updates information for use by office staff for the appropriate utilization of specific health plans, IPAs, Managed care, etc., responds to questions for clarification.Assists medical/dental providers with the credentialing/re-credentialing process in a timely manner including: Hospital appointment/re-appointment of staff privileges, Health plans/IPAs, Managed care organizations, J-1 visa and H-1 B physician, Renewal of licensure, Maintain NPI online provider & clinic site filesAlso includes review and follow-up of information submitted, processing of fees, completion of forms, ensures accuracy and detail.Acts as a resource for patient/staff regarding provider status with various health plans/programs; assists Billing Department with claim issues.Maintains computerized and hard copy credentialing files for all practitionersMonitors practitioners enrollment with Medicare/Medicaid and MCO's to ensure proper participation dateKeep Manager informed of concerns or problems with credentialing processes.Prepare correspondence, memos, and reports as directed.Project our patient centered culture to the staff, patients and community we serve. Integrate CARE into all aspects of office and professional duties.Keep up-to-date files of all correspondence, memos, and agreements for department. Organize contacts for accuracy and efficiency.Handle confidential information and matters of discretion in a professional manner.Assist with special projects as required.Min. Qualifications Knowledge of TJC and NCQA Standards and medical terminology.SKILLS: demonstrated organizational skills; strong working knowledge of Microsoft Word and Excel; written, proofing and composition skillsABILITY TO: Meet deadlines and prioritize tasks; effectively interact with community, operational and clinical personnel; wide range of creativity and flexibility; plan, organize, coordinate, and monitor the work of committees.Physical Demands The employee must occasionally lift and/or move up to 25-50 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.Work Environment The noise level in the work environment is usually quiet.Education/Experience Requirements HS Diploma or equivalent requiredAssociates Degree preferredMinimum of 1 (one) year of health care credentialing experience required.

Keywords: Golden Valley Health Centers, Merced , Credentialing Specialist - Merced, Other , Atwater, California

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