Provider Enrollment Credentialing Specialist

Job Description

Job Description

Description :

Title : Provider Enrollment & Credentialing Specialist

Base Salary Range : $51,549 - $77,024 plus benefits

FTE : Non-Exempt, Full Time

General Summary : The Provider Enrollment & Credentialing Specialist is responsible for leading, coordinating, monitoring, and maintaining the credentialing and re-credentialing process.

Facilitates all aspects of SCFHC credentialing, including initial appointment, reappointment, and expiration process, as well as clinical privileging for Medical Staff, Allied Health Professionals, and all other providers outlined in the SCFHC Bylaws, policies, or related contracts.

• Ensures that credentialing and re-credentialing of providers occurs on a timely basis.
• Works collaboratively with a wide range of healthcare professionals, including providers, other healthcare leaders, and fellow employees at the local and company-wide levels.
• Leads, coordinates, and monitors the review and analysis of practitioner candidates’ applications for their credentials to ensure they are eligible for employment and meet SCFHC credentials standards.
• Ensures compliance with applicable federal and / or state laws, regulations, and / or agency rules, contract standards, and guidelines regarding credentialing and program enrollment.
• Oversee the collection of all pertinent primary source verification for all providers and practitioners. Run newly hired practitioners credentials across five different primary source verification databases (NPPES, OIG, NPDB, DEA, Breeze).
• Prepares credentials file for completion and presentation to the internal Credentialing Committee and Corporate Medical Committee, ensuring file completion within the time periods specified and obtains required signatures.
• Serves as a delegate for physician / practitioner applications and reviews for completeness / accuracy of the completed application.

Coordinates with physician / practitioner if erroneous information on application needs to be updated.

Assist with pre-populating the mid-levels scope of work application such as the Nurse Practitioner Protocols and the Physician Assistant Delegation Agreements.

Once complete, submit to Medpoint for processing.

• Coordinates with various departments regarding audit preparation, staff training, and compliance related to credentialing.
• Coordinate with the managed care department and scheduler regarding provider panels and provider assigned locations to update provider credentialing files and the IPA.
• Provides administrative support, including answering phones, taking messages, and distributing route messages accordingly.
• Assist the Medical Administration Supervisor with monthly provider meetings. Send members the calendar invites and reminder emails.

Draft agenda and minutes and disseminate for review.

• Coordinate the onboarding process for all medical students, preceptors, and internships. Including collecting contract service agreements, applications, etc.
• Process all mail and correspondence for the Medical Administration office.

Qualifications :

• AA degree Required.
• Bachelor’s degree preferred.
• High School Diploma or equivalent required.
• Current California Driver’s License and Automobile Insurance.

Top benefits or perks : As a team member at South Central Family Health Center, you’ll enjoy competitive wages and generous benefits :

• Benefits : Health Care, Dental, Life Insurance
• 403 (b) Retirement plan
• Education Reimbursement

Career development : Entry-level employees have opportunities to work in management, HR or other areas of the company .

Requirements :