Medical Staff Credentialing Specialist, Sr. jobs in San Francisco, CA

The Role: 

The Credentialing Specialist will be responsible for all aspects of the credentialing, re-credentialing and privileging processes for all medical providers who provide patient care at Mochi Health. In this role, the Credentialing Specialist will be responsible for ensuring providers are credentialed, appointed, and privileged with health plans and maintain up-to-date data for each provider in credentialing databases and online systems, ensuring timely renewal of licenses and certifications. Understands managed care billing, credentialing and enrollment requirements and reimbursements methodologies and applies knowledge to identify, quantify, and address missing/incorrect charges. Assist in the development of resources for researching issues.

You Will:

• Identify discrepancies in information and conduct follow-ups.
• Process initial credentialing and re-credentialing applications with follow up to ensure that credentialing is completed, and providers are successfully enrolled in health plan products.
• Maintain internal and external databases (e.g., CAQH)
• Assist internal stakeholders with credentialing inquiries.
• Coordinate and facilitate troubleshooting with payer networks to resolve any issues related to enrollments.
• Perform provider roster reconciliation with health plans and audit provider directories.

About You:

• Intermediate computer skills including Microsoft Office; especially Word, Excel, and PowerPoint.
• Excellent interpersonal skills including the ability to interact effectively and professionally with individuals at all levels; both internal and external
• Exercise sound judgment in responding to inquiries; understand when to route inquiries to next level.
• Self-motivated with strong organizational skills and superior attention to detail
• Must be able to manage multiple tasks/projects simultaneously within inflexible time frames. Ability to adapt to frequent priority changes.
• Team player that develops strong collaborative working relationships with internal partners and can effectively engage and ability to build consensus among cross-functional teams

Requirements: 

• High school diploma/GED required
• 2 years of experience working for a telehealth platform, health maintenance organization, health plan, provider office and/or in another health insurance-related setting.
• Experience with provider and practitioner credentialing process, timeframes and appeal options; health plan design, contracting, plan policies and procedures.
• Experience processing primary source verifications.
• Experience with Credentialing Committee and case file preparation.
• Ability to build professional cross functional working relationships among all levels of the organization.
• Ability to make valid judgments, formulate recommendations or action plans, and evaluate the effects of decisions and actions.

Life At Mochi

• Medical/Dental/Vision Insurance
• Company Paid Life Insurance
• 401k with Company matching
• Competitive PTO and Company Holidays
• Emphasis on Wellness: Group activities, mindfulness exercises, physical exercise

The base salary for this full-time position ranges from $60,000 and $80,000 per year, in addition to benefits. The salary range listed in each job posting represents the minimum and maximum targets for new hire salaries across all locations. Actual compensation within this range is determined by various factors, such as job-related skills, experience, relevant education or training, and location.

Join Us at Mochi Health!

If you're here, chances are you share our passion for transforming the connection between providers and patients to explore evidence-based weight loss strategies. We invite you to apply, whether or not you meet every requirement listed. At Mochi, we value individuals who are intelligent, curious, and dedicated to our mission, over those who simply check all the boxes.

Please note that Mochi Health does not accept agency resumes. Kindly refrain from forwarding resumes to any recruiting alias or employee. Mochi is not responsible for any fees related to unsolicited resumes.