Credentialing Coordinator
Job Details
Experienced
The David Geffen Center - Los Angeles, CA
Full Time
2 Year Degree
Undisclosed
Up to 25%
Day
Human Resources
Description

POSITION SUMMARY:

Under the guidance of the Associate Director of Human Resources, the Credentialing Coordinator is responsible for the timely gathering, reviewing and compiling of provider application information to be submitted to the appropriate credentialing service. Ensures interpretation and compliance with the appropriate credentialing regulations. The Credentialing Coordinator is also responsible for the accuracy and integrity of the CAQH and credentialing tracking databases. Acts as the liaison between the credentialing services and APLA Health & Wellness.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES:

  • Responsible for the timely gathering and submitting for processing to IPA’s and health plans on an ongoing basis, all credentialing and re-appointment applications.
  • Sit with provider to complete credentialing application when necessary.
  • Tracks all pending applications and notifies the Director of Human Resources of any challenges with obtaining provider information.
  • Responsible for reviewing and verifying all credentialing documentation for providers, confirming consistency and accuracy based on regulatory requirements.
  • Coordinates review and approval of clean files by the Medical Director.
  • Prepares credentialing documentation for the Risk Management and Compliance Committee.
  • Prepares credentialing documents for approval from the Medical Director, Dental Director, or Behavioral Health Director, CEO and the Board. 
  • Assists Director with credentialing audits.
  • Maintains accuracy and integrity of the CAQH and credentialing tracking databases.
  • Maintains provider credentialing files in Paycom and conducts internal file audits to ensure accuracy and efficiency throughout the credentialing process.
  • Responsible for obtaining monthly reports from IPA’s.
  • Obtain privileging and competency documentation for clinical staff.
  • Works with internal and external customers on day-to-day credentialing and privileging issues and requests as they arise.

 

OTHER DUTIES MAY BE ASSIGNED TO MEET BUSINESS NEEDS.

Qualifications

REQUIREMENTS:

Training and Experience:

AA degree and 2 years credentialing experience or equivalent combination of education and experience. Must be detailed oriented and possess strong organizational skills.  Possess effective oral and written communication skills, proficient in the use of Microsoft Office: Word, and Excel.  Previous experience with Paycom or other HRIS application a plus.

 

Knowledge of:

CAQH preferred.

 

Ability to:

Work with people of diverse cultural, educational, social and economic backgrounds.  Must possess the ability to follow instructions and exercise good judgment.  Ability to thrive in a fast paced dynamic work environment and meet all deadlines.

 

WORKING CONDITIONS/PHYSICAL REQUIREMENTS:

This is primarily an office position that requires only occasional bending, reaching, stooping, lifting and moving of office materials weighing 25 pounds or less. The position requires daily use of a personal computer and requires entering, viewing, and revising text and graphics on the computer terminal and on paper.

 

SPECIAL REQUIREMENTS:

Must possess a valid California driver’s license; proof of auto liability insurance; and have the use of a personal vehicle for work related purposes. May be required to drive to other APLA sites to obtain credentialing information.

 

WORKING CONDITIONS/PHYSICAL REQUIREMENTS:

This is primarily an office position that requires only occasional bending, reaching, stooping, lifting and moving of office materials weighing 25 pounds or less. The position requires daily use of a personal computer and requires entering, viewing, and revising text and graphics on the computer terminal and on paper.

 

Equal Opportunity Employer: minority/female/disability/veteran.

 

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