Macman Management is seeking a Credentialing Specialist to join our growing company. Under the direction of the Credentialing & Enrollment Manager, the Credentialing Specialist evaluates, analyzes, and coordinates all aspects of clinical competency, clinical compliance, and provider on-boarding as they pertain to HRSA guidelines Chapter 5: Clinical Staff On-Boarding.

***LOOKING FOR APPLICANTS IN THE LOS ANGELES, CA AREA***

Qualified candidates should possess:

• Minimum of 1 year Healthcare/Healthplan Enrollment Experience (Required)
• Minimum of 1 year of full-time experience in all facets of credentialing, including interactions with healthcare providers (Required)
• Minimum of High School Diploma or equivalent (Required)

ESSENTIAL DUTIES AND RESPONSBILITIES:

• Reviews and screens Initial and Re-credentialing HR applications for completeness, accuracy, and compliance with federal, state, and local guidelines, MMHCS policies, and standards.
• Conducts primary source verification (PSV), collects and validates documents to ensure accuracy of all credentialing elements; assesses completeness of information and qualifications relative to credentialing standards
• Identifies, analyzes and resolves extraordinary information or discrepancies that could adversely impact ability to credential and enroll practitioners; discovers and conveys problems to Credentialing Manager for sound decision making in accordance with credentialing policies/procedures and federal, state, local and government/insurance agency regulations.
• Monitors files to ensure completeness and accuracy; reviews all file documentation for compliance with quality standards, accreditation requirements, and all other relevant policies; prepares and provides information to internal and external customers as appropriate.
• Enters, updates and maintains data from provider applications into credentialing database, focusing on accuracy and interpreting or adapting data to conform to defined data field uses, and in accordance with internal policies and procedures.
• Prepares, issues, electronically tracks and follows-up on appropriate verifications for efficient, high-volume processing of individual provider applications in accordance with applicable credentialing standards, established procedural guidelines, and strict timelines.
• Communicates clearly with providers, their liaisons, medical staff leadership and Administration, as needed to provide timely responses upon request on day-to-day credentialing and privileging issues as they arise.
• Coordinate the credentialing process, as outlined in the agency’s policy for all new providers, including employees, volunteers, locums, and independent contractors.
• Collaborate with the HR and locum agencies to monitor recruitment status of candidates to ensure timely credentialing prior to employment.
• Communicate with clinic managers to ensure the re-credentialing requirements are met and maintained.
• Maintain and closely monitor clinical license, certification, and/or required regulatory registration (DEA, BLS, etc.) for all providers to ensure credentialing and provider requirements are always current.
• Work with the Credentialing Department to ensure adherence to quality standards, deadlines, and proper procedures, correcting errors and problems.
• Attend staff meetings as necessary.
• Fill out business or government forms.
• Participates in the development and implementation of process improvements for the system-wide credentialing process; prepares reports and scoring required by regulatory and accrediting agencies, policies and standards.
• Delegate actionable items to peers and ensure completion in a timely manner.
• Participate in the preparation client credentialing agendas.
• Maintains professional growth and keeps abreast of latest developments to enhance understanding of various regulations and legislation of the health care industry.
• Performs miscellaneous job-related duties as assigned.

Required Skills:

• Knowledge of FQHC guidelines and policies. Knowledge of Clinical Staffing guidelines
• Renewals of Facility Licensing
• Apply for and Update NPI records.
• Process and file applications with third party vendor according to each vendor’s individual requirements and addresses/corrects discrepancies as requested by vendors.
• Renewals of CLIA/CLR Applications
• Ensure all records meet standards set by carriers as well as FQHC guidelines
• Ability to attention to detail.
• Excellent communication skills; must be able to work in a team environment.
• Effective verbal and written communication.
• Excellent attention to detail and accuracy.
• High-level of organizational skills
• Demonstrate the ability to perform tasks involving independent judgement.
• Must be able to use spreadsheet software
• Must be able to use word processing or desktop publishing software
• Must use logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
• Must be able to identify technical challenges based on credentialing denials and contact DHCS, CMS and other insurances to trouble shoot.

Job Type: Full-time

Pay: $22.00 - $25.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Experience:

• Healthcare/Healthplan Enrollment: 1 year (Required)
• Credentialing: 1 year (Required)
• Excel: 1 year (Required)

Work Location: Remote

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