POSITION PURPOSE:
The Credentialing Coordinator is responsible for the coordination and implementation of all aspects of the credentialing, re-credentialing, privileging, and enrollment processes for providers and licensed staff as indicated in the Credentialing and Privileging policy.
MAJOR POSITION RESPONSIBILITIES AND FUNCTIONS:
• Review practitioners’ applications and supporting documents for completeness and to ascertain their eligibility for initial and renewal of privileges. Liaise with applicants to ensure that all applications are completed and processed appropriately.
• Identify discrepancies in information on initial and recredentialing applications and conduct follow-ups on a timely basis.
• Initiate verification of all information contained therein as well as ensuring that request for privileges are appropriate based on set criteria.
• Initiate electronic verification of licensure and other certifications. As necessary, conduct manual verification of credentials (previous work verifications, claims history, peer
references, etc.) for institutions not currently using online verifications.
• Ensure in-house initial credentialing and recredentialing processes is completed within the required timeframe.
• Ensure initial credentialing documentation is received by IPAs, health plans, including behavioral health plans within the required timeframe.
• Ensure health plan and IPA recredentialing processes are completed within the required timeframe.
• Submit initial provider applications/enrollments to various payor programs (PAVE, PECOS) within the required timeframe.
• Complete initial enrollment or review, and maintenance of provider CAQH profiles for health plan credentialing.
• Complete health plan and IPA re-credentialing requests.
• Respond to all IPA and health plan provider inquiries.
• Monitor upcoming dates for recredentialing applications; initiate process within required timeframe prior to due date.
• Monitor upcoming expiration of provider documents/certifications withing required timeframe; assist providers as needed to obtain updated information.
• Maintain confidentiality of all provider information within credentialing database, as well as all documentation gathered throughout the credentialing process.
• Maintains accurate, up-to-date files and rosters on all clinical providers for EVCHC.
• Participate in administrative staff meetings and attends other meetings, and seminars.
POSITION REQUIREMENTS AND QUALIFICATIONS:
• High school diploma, GED, or suitable equivalent.
• 2+ years of credentialing experience with hospital or community health center medical staff.
• Basic knowledge of medical credentialing and privileging procedures and standards.
• Knowledge of provider enrollment procedures for PAVE, PECOS, CAQH.
• Strong written and verbal communication skills.
• A high level of detail orientation and multi-tasking ability.
• Excellent customer service skills.
• Proficient with Microsoft Office products (Word, Excel, Outlook, SharePoint).
• Problem solving/analysis with an understanding of common credentialing practices and knowledge.
• Project management ability from conception to execution and delivery on timeline.
WORKING CONDITIONS/PHYSICAL/MENTAL ABILITIES AND PROCESS:
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions.
• Work requires periods of standing, sitting, lifting, turning, twisting, walking, pushing, pulling, reaching, speaking, hearing, seeing and ability to articulate clearly, use of hands to finger, reaching with hands and arms.
• Ability to write notes, track records and reports.
DOE: $27.00 - $31.88
East Valley offers a competitive salary, and excellent benefits including medical, dental, vision, and defined contribution retirement plan. You will also enjoy a work-life balance with paid time off and paid holidays throughout the year.
Please apply to this position with your current resume.
Principals only. Recruiters, please do not contact this job posting.
EOE is the Law. It is the stated policy of EVCHC to conform to all the laws, statutes, and regulations concerning equal employment opportunities and affirmative action. We strongly encourage women, minorities, individuals with disabilities, and veterans to apply to all of our job openings. We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, or national origin, age, disability status, Genetic Information & Testing, Family & Medical Leave, protected veteran status, or any other characteristic protected by law. We prohibit Retaliation against individuals who bring forth any complaint, orally or in writing, to the employer or the government, or against any individuals who assist or participate in the investigation of any complaint or otherwise oppose discrimination.
Our Mission
To provide access to excellent health care while engaging and empowering our patients, employees and partners to improve their well-being and the health of our communities.
Who We Are
We are a Federally Qualified Health Center (FQHC) that provides family medicine, pediatrics, women’s health, behavioral health, dental and vision services to individuals across the East San Gabriel Valley and Pomona Communities. We practice patient-centered care and strive to serve each patient with the care that meets their individual needs.
Who We Serve
Our service area is a large, diverse, complex and rapidly changing geographic area that is home to over 700,000 people and faces significant challenges in chronic disease, including diabetes, hypertension and asthma. The majority of our patients are the working poor, and 62% are uninsured. East Valley holds public and private contracts with many funding sources, which allow us to provide medical services at very low cost to qualifying individuals. East Valley is also affiliated with two local IPAs and holds managed care contracts with most health plans operating in California. Fees for our services are on a sliding scale, but no one is turned away because of inability to pay. East Valley accepts all public health insurance, such as Medi-Cal (also known as Medicaid), Medicare, and public programs such as My Health L.A. as well as private health insurance.
Most importantly, if you or your family are not covered by any health insurance plan, our certified enrollment counselors will help you apply for Covered CA, Medi-Cal, Medicare so you can be assured your that you are accessing the best coverage options for and your family. If you don’t qualify for health insurance we can assist you with public programs, such as My Health L.A. (MHLA) in accordance to their eligibility requirements.
East Valley is a medical home for people who cannot be seen or cared for anywhere else.
