Medical Staff Credentialing Manager jobs in Long Beach, CA

Credentialing Coordinator

Role Insights

This role of a Credentialing Coordinator is considered an essential position within the organization. This individual is responsible for verifying the credentials of our contracted practitioners and ensuring they meet all requirement regarding state licensure, graduate education, and training as per AMM, NCQA, CMS as well as our contracted health plans guidelines. The Credentialing Coordinator also ensures that health-care providers update their certification or licensing on time.

The right candidate should have confidence in their abilities as a problem solver and have the poise to execute assignments in a timely fashion with little to no errors. Good time management is essential.

Primary Responsibilities

· Performs initial credentialing of providers, including but not limited to:

- Entry of provider information into EZCap as well as our proprietary Provider Network Program application.

- Process outgoing and incoming primary source verifications.

- Process OIG, SAM, Medicare Opt-Out and Preclusion List sanction verifications.

- Process NPDB, AMA as well as multiple other verification as applicable.

- Ensure application complies with all standard credentialing requirements.

- Prepares files for Credentialing Committee review.

- Process Credentialing Committee review results including Minutes, system updates, post-committee, notification letters to providers and internal staff.

· Performs re-credentialing process every three (3) years of active providers within the network, including but not limited to:

- Identify providers that are due for re-credentialing.

- Process re-credentialing applications.

- Process outgoing and incoming primary source verifications.

- Process OIG, SAM, Medicare Opt-Out and Preclusion List sanction verifications.

- Process NPDB, AMA as well as multiple other verification as applicable.

- Process peer review.

- Prepares files for Credentialing Committee review.

- Process Credentialing Committee review results including Minutes and system updates and notification letters to providers.

· Check provider status.

· Responsible for EZCAP and Provider Network Program application maintenance for all credentialed contracted providers, including but not limited to:

- Demographic updates.

- Termination.

- Activation of new providers.

- Other data, as deemed necessary.

- Responsible for creating and/or maintaining credentialing provider roster.

- Performs other duties, as required, or assigned.

Required Skills and Abilities

· Minimum 2 years of administrative healthcare experience preferred.

· Credentialing audit experience preferred.

· Knowledgeable in Microsoft Word & Outlook, Excel, and Adobe Pro.

· Excellent communication skills.

· Excellent organizational skills and time management.

· Highly detail-oriented.

· Ability to work independently as well as in a team environment.

· Strong ability to multi-task and work in a fast-paced environment

· Strong ability in problem-solving.

· Strong verbal and written communication skills.

· Ability to work Monday through Friday 8:00am – 5:00pm

AAP/EEO Statement

It is the policy of Advanced Medical Management to provide equal opportunity for all applicants and employees. The Company does not unlawfully discriminate on the basis of race, creed, color, religion, sex sexual orientation, gender, gender identity, national origin, ancestry, age, medical condition or genetic characteristic, physical or mental disability, family care or medical leave status, military status, pregnancy, marital or domestic partner status, veteran status, or any other status protected by state or federal law.

Job Type: Full-time

Pay: $22.00 - $26.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Ability to Commute:

• Long Beach, CA 90815 (Required)

Work Location: In person