Credentialing Coordinator / Job Req 721743116

Overview

Hybrid : Full Time must live in one of 6 states : CA, AZ, NV, TX, WA, OR; remote and on site in Alameda County. Available for Full-Time Work Schedule 8 : 00am - 5 : 00pm Pacific Time, Monday-Friday. Hybrid positions work a minimum of up to 2 days per week in Alameda Alliance for Health's office, located at Alameda CA, and a minimum of three days per week remotely.

PRINCIPAL RESPONSIBILITIES

The Credentialing Coordinator works under the supervision of the Manager, Peer Review and Credentialing and assists in all aspects of the Credentialing department functions. The Credentialing Coordinator is responsible for coordinating, monitoring and maintaining the credentialing and recredentialing processes of health care providers and practitioners to ensure they meet the requirements of the Alliance credentialing policies and regulatory agencies (i.e., Title 22, NCQA, DHCS, DMHC, and CMS).

Principal responsibilities include :

Application Maintenance

• Prepare initial application requests for Chief Medical Officer or Medical Director review.
• Send and track application requests.
• Evaluate applications for completeness and compliance.
• Coordinate initial and recredentialing file processing with Credentialing Verification Organization (CVO).
• Audit files, obtain credentialing documents, or additional information as required.
• Track and follow up on all credentialing / recredentialing documentation as necessary.
• Contact practitioners to clarify discrepancies.
• Ensure application timeliness per NCQA requirements.

Credentialing Database Maintenance

Peer Review and Credentialing Committee Maintenance

Credentialing Requirements Maintenance

ESSENTIAL FUNCTIONS OF THE JOB

PHYSICAL REQUIREMENTS

MINIMUM QUALIFICATIONS

EDUCATION OR TRAINING EQUIVALENT TO :

MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE :

SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE) :

SALARY

Salary RANGE $27.11 - $40.66 HOURLY

The Alliance is an equal opportunity employer and makes all employment decisions on the basis of merit and business necessity. We strive to have the best-qualified person in every job. The Alliance prohibits unlawful discrimination against any employee or applicant for employment based on race, color, religious creed, sex, gender, transgender status, age, sexual orientation, national origin, ethnicity, citizenship, ancestry, religion, marital status, familial status, status as a victim of domestic violence, assault or stalking, military service / veteran status, physical or mental disability, genetic information, medical condition, employees requesting accommodation of a disability or religious belief, political affiliation or activities, or any other status protected by federal, state, or local laws.

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