Provider Contracting Manager jobs in Modesto, CA

POSITION TITLE: Credentialing & Contracting Associate

LOCATION: Angels Camp, California

STATUS:  Full-Time, Non-Exempt

STARTING SALARY: $24.56-$29.31

Under the supervision of the Credentialing & Contracting Specialist, this position is responsible for all aspects of the credentialing, contracting, and re-credentialing processes for all MACT providers who provide patient care at any site for MACT Health Board, Inc. The Associate must also work in conjunction with the Compliance and Human Resources Department as it pertains to the development of departmental policies and procedures and provide support services in monitoring the continuity of the healthcare staff activities. 

  PRIMARY RESPONSIBILITIES 

1. The Associate must follow a formal and documented program that ensures verification of all necessary credentials for every job applicant by using available resources to verify all credentials.
2. The Associate shall monitor the privileges that are delineated in the provider’s job description or as part of his or her employment contract and that, they are also within the “scope of project”.
3. The Associate must coordinate Credentialing and Privileging before any individual is allowed to provide patient care services.
4. The Associate must review an exclusion list on a regular basis. 
5. The Associate must ensure that a licensed or certified health care practitioner meets all state, federal, and organization credentialing requirements, which must be documented, in writing, and kept in the practitioner’s personnel files in secure, locked location.
6. The Associate shall monitor a tracking system for license, DEA, certificates and professional liability expirations and will maintain a database on all providers.
7.  If the practitioner is privileged to provide services outside of a health center’s scope of project, the Associate must inform the Credentialing Specialist to take proper action.
8.  The Associate must review and verify all documents for completeness and accuracy, and keep up-to-date records of provider credentials.
9.  The Associate will work in conjunction with the Credentialing Specialist to setup new contracts, update provider rosters, and perform any verifications required with all accepted health plans. 
10.  The Associate will maintain all clinic licensing including new applications, updates, and renewals. 
11.  Support maintenance and protect confidentiality of all personnel policies and procedures.
12.  Support maintenance of HRIS database and electronic records, assists in the continuity of confidential employee information.
13.  Upon request, assist with special HR projects.  

OTHER FUNCTIONS

1. Provide support when processing provider CME (Continuing Medical Education) requests.

2.  Provide support to the Human Resources, Billing and AP Departments.

MINIMUM QUALIFICATIONS:

1.  BA Degree in Healthcare Administration or 3 years of progressively responsible experience in a health care setting. 
2. Ability to manage multiple projects and interact with patients and staff in a positive manner.
3. Must have the ability to present findings and train large groups of people and possesses the ability to work with a multi-disciplinary team.
4. Working knowledge of Microsoft applications.
5. Must be able to read, analyze, and interpret the most complex documents. Able to respond effectively to the most sensitive inquiries or complaints.   

MANDATORY QUALIFICATIONS:

1. Must be skilled and proficient in usage of personal computer, including electronic email, record keeping, routine database activity, word processing, spreadsheet, graphics, etc.
2. Must pass Occupational Health Screening.
3. Possesses a valid form of identification as listed on the U. S. Department of Justice I-9 form and processed/authorized using E Verify.
4. Must be insurable under MACT Auto insurance.

DESIRED ABILITIES

1.     Knowledge of basic medical clinic procedures.

2.     Professionalism addressing the staff and the public.

3.     Ability to use oral and written skills effectively.

4.     Ability to communicate in a pleasant and positive manner.

5.     Ability to work both independently and with others and be flexible and responsible.

6.     Intermediate level computer and software skills.

7.     Requires tact, courtesy, discretion, resourcefulness and good judgment in a sensitive manner.

8.     Ability to lift cartons, files, forms or supplies up to 50 lbs.

AMERICAN INDIAN PREFERENCE: 

Preference in filling of a vacancy will be given to qualified American Indian applicants in accordance with the Preference Act (Title 25, U.S. Code, Sections 472 & 473) and Public Law 93-638, provided the applicant has submitted appropriate verification of Indian preference for employment.  Other than the aforementioned requirement, the MACT Health Board, Inc. is an Equal Opportunity Employer.

NOTICE OF DRUG-FREE WORKPLACE ACT REQUIREMENT:

MACT Health Board, Inc. is required to implement the Drug-Free Workplace Act of 1988, 45 CFR Part 79, Subpart F.  As such it is unlawful for employees to manufacture, distribute, dispense, possess, or use a controlled substance on the job site.  Employees who are reasonably suspected of violating this act may be subject to drug testing as a condition of employment.  Employer required fitness examinations shall include drug testing as evidence of employee and employer compliance with the Drug-Free Workplace Act.