CA - Orange
TEMP - Credentialing Coordinator
**IN-OFFICE TEMP ONLY POSITIONS. 9 am - 5 pm Monday thru Friday.
The Credentialing Coordinator will perform verification and processing of moderately complex to advanced-level documents and database information. The incumbent will use standard policies, procedures, and guidelines for the coordination, monitoring, and processing of credentialing and re-credentialing of Behavioral Health practitioners, providers, mid-levels, Applied Behavioral Analyst (ABA), and Board Certified Behavioral Analyst (BCBA), allied health professionals and other Organizational Provider (OP) based on regulatory, accreditation, contractual and our standards.
- Ensures that the required timely documentation is appropriate and complete for verification processing, which includes but is not limited to the following providers: Behavioral Health practitioners, providers, ABAs, BCBAs, mid-levels, allied health professionals, and other health care delivery organizations for the credentialing and re-credentialing process.
- Processes all credential applications, initials, and re-credentials and applications in established electronic file folders.
- Conducts other follow-ups as required into the applicant's background, education, and experience using online systems, written correspondence, telephone inquiries, and printed reference guides and reports.
- Performs and collects primary source verification (PSV) documentation for licensing, board certifications, proof of required insurance, National Practitioner Data Bank (NPDB), and other sources as needed based on National Committee for Quality Assurance (NCQA) standards, our requirements, and policies.
- Partners with all necessary staff to ensure an integrated, timely, and consistent product.
- Collaborates with the Provider Relations and Contracting department on the status of candidates to ensure timely credentialing.
- Prepares reports as requested. Monitors and maintains reports published by the Medical Board of California (MBOC), Centers for Medicare and Medicaid Services (CMS), Department of Healthcare Services (DHCS), Office of Inspector General (OIG), NPDB, and other applicable sources to identify adverse findings.
- Implements an efficient and effective system for the transmission of credential information to internal and external sources to facilitate timely approval to participate as an approved practitioner, provider, or OP.
- Provides consistent and timely follow-up on all outstanding credentialing and re-credentialing files.
- Maintains the credentialing database and ensures up-to-date information is always obtained.
- Stays aware of changes and updates in laws and regulatory requirements.
- Writes, revises, and implements desktop procedures as necessary to remain in compliance and create efficiency.
- Documents the monitoring of adverse license actions and legal actions.
- Cross-train within the department to support credentialing operations to provide back-up support for credentialing files during department absences such as vacation or paid time off.
Possesses the Ability To:
- Function independently with minimal direct supervision and be detail-oriented.
- Organize credentialing processes and understand and apply credentialing criteria consistently across our company, health networks, and physician medical groups.
- Maintain confidentiality of peer review information.
- Communicate clearly and concisely, both verbally and in writing.
- Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job-specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
Experience and Education
- High School diploma or equivalent required.
- 2 years of experience with credentialing in a hospital or ambulatory setting, such as a health plan, medical group or Independent Physician Association (IPA) required.
- An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.
- Bachelor’s degree in Healthcare Administration or related field.
- Certification as Certified Provider Credentialing Specialist (CPCS).
- Medical Terminology.
- Credentialing standards, requirements and processes and procedures
- Federal and state regulatory requirements and accreditation standards: NCQA, The Joint Commission, DHCS, DMHC, CMS and other relevant or accreditation certifying agencies.
At Sunshine Enterprise USA LLC, we firmly believe that our employees are the heartbeat of our organization, and we are happy to offer the following benefits:
- Competitive pay & weekly paychecks
- Health, dental, vision, and life insurance
- 401(k) savings plan
- Awards and recognition programs
- Benefit eligibility is dependent on employment status.
Sunshine Enterprise USA is an “Equal Opportunity Employer—Minorities, Females, Veterans and Disabled Persons”