Credentialing Coordinator

US-CA-Los Angeles
Job ID
2017-5502
Category
Office/Clerical

Overview

Under the direction of the Director Patient Care Services, the Credentialing Coordinator is responsible for processing initial and reappointment credentialing applications for physician and mid-level providers including dental providers. Works collaboratively with all members of the credentialing department, Administration, physicians and health care providers to coordinate, develop, monitor and maintain the credentialing process. Ensures accurate, complete and timely functioning of the appointment and reappointment processes. Prepares credentialing files for presentation to the Credentialing Committee as well as to State Agency and Health Plans audits.

Responsibilities

  1. Executes appointment and reappointment applications in accordance with the Credentialing to assure time frames are met and that regulatory standards are met.
  2. Responsible for continuous collection of information pertaining to the physicians, dentist and mid-level providers at each facility and follows-up for missing and/or expired information to comply with regulatory agencies and credentialing policies.
  3. Completes the investigative process for appointment and re-appointment applications and works with department heads to finalize application.
  4. Appropriately completes and processes all inquiries to the National Practitioner Data Bank, AMA/AOA and other essential verifications for all initial and reappointment applications.
  5. Diligently initiates all follow-up communications required to adequately research and secure information necessary to facilitate the committee's goals.
  6. Responsible for the accuracy and integrity of data entered into the credentialing database system.
  7. Prepare Credentialing Committee Agenda and minutes according to required standards and guidelines, and perform follow-up from committee.
  8. Actively participates in assigned committee meetings, including, but not limited to, the QM and Credentialing Committee.
  9. Facilitate external reporting as needed, including, but not limited to health plan requirements, corrective action plan and 805.
  10. Actively participate in annual health plan audits, including corrective action plans as needed.
  11. Work closely with contracted providers ensuring credentials are current with contracted plans.
  12. Performs other duties as assigned. 

Qualifications

  1. Some college coursework or Associates degree required.
  2. A minimum of 3 years experience in the field of Health Care Credentialing.
  3. Certified Provider Credentialing Specialist (CPCS) or achieve certification within 1 year of employment. 

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