Credentialing Coordinator California
Company: Sunshine Enterprise USA LLC
Posted on: September 16, 2023
TEMP - Credentialing Coordinator
**IN-OFFICE TEMP ONLY POSITIONS. 9am - 5pm 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, that 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
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
Writes, revises and implements desktop procedures as necessary to
remain in compliance and create efficiency.
Documents the monitoring of adverse license actions and legal
Cross-train within 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
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
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
Experience and Education
High School diploma or equivalent required.
2 years of experience with credentialing in a hospital or
ambulatory setting, such as 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
Certification as Certified Provider Credentialing Specialist
Credentialing standards, requirements and processes and
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"
Keywords: Sunshine Enterprise USA LLC, Orange , Credentialing Coordinator California, Other , Orange, California
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