Posted on: September 17, 2023
Equiliem specializes in staffing clinical, non-clinical, and
allied personnel. We excel in all levels, disciplines, and
specialties within the healthcare spectrum. Our projects range from
short to long term local and travel assignments. Equiliemhas been
recognized as a certified small business enterprise. In addition,
we are proud that we have earned the prestigious Joint Commission
accreditation for staffing firms and have been awarded Best in
Staffing 5 years running by our employees and client partners.
**IN-OFFICE TEMP ONLY POSITIONS. 9am - 5pm Monday to 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 standards.
- Participates in a mission-driven culture of high-quality
performance, with a member focus on customer service, consistency,
dignity and accountability.
- Assists the team in carrying out department responsibilities
and collaborates with others to support short- and long-term
goals/priorities for the department.
- 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
- 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, 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
- 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 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
- Completes other projects and duties as assigned.
Possesses the Ability To:
- Function independently with minimal direct supervision and be
- Organize credentialing processes and understand and apply
credentialing criteria consistently across direct, health networks
and physician medical groups.
- Maintain confidentiality of peer review information.
- Establish and maintain effective working relationships with
leadership and staff, as well as contracted committee members and
practitioners with sensitive issues.
- 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
- Medical Terminology.
- 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.
Keywords: Equiliem, Orange , Credentialing Coordinator, Other , Orange, California
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