ATWATER, CA 95340
Merced County Areas
Hire Up Staffing Services in Merced is currently searching for a Credentialing Specialist or Assistant that will provide skilled support to the company’ s credentialing processes and functions, must have knowledge of TJC and NCQA Standards and Medical Terminology. Anyone with these skills we encourage you to apply! Great Career Opportunities for growing companies in the community!
- Demonstrates effective communication and problem-solving skills.
- Will identify, obtain and verify credentials for all licensed practitioners for initial credentialing and re-credentialing.
- Compiles, creates and updates information for use by office staff for the appropriate utilization of specific health plans, IPAs, Managed care, etc., responds to questions for clarification.
- Assists medical/dental providers with the credentialing/re-credentialing process in a timely manner including: Hospital appointment/re-appointment of staff privileges, Health plans/IPAs, Managed care organizations, J-1 visa and H-1 B physician, Renewal of licensure, Maintain NPI online provider & clinic site files
- Also includes review and follow-up of information submitted, processing of fees, completion of forms, ensures accuracy and detail.
- Acts as a resource for patient/staff regarding provider status with various health plans/programs; assists Billing Department with claim issues.
- Maintains computerized and hard copy credentialing files for all practitioners
- Monitors practitioners enrollment with Medicare/Medicaid and MCO' s to ensure proper participation date
- Keep Manager informed of concerns or problems with credentialing processes.
- Prepare correspondence, memos, and reports as directed.
- Project our patient centered culture to the staff, patients and community we serve. Integrate CARE into all aspects of office and professional duties.
- Keep up-to-date files of all correspondence, memos, and agreements for department. Organize contacts for accuracy and efficiency.
- Handle confidential information and matters of discretion in a professional manner.
- Assist with special projects as required.
• Similar to the Specialist, the Assistant would have knowledge of such processes, but lighter in experience.
• Follow-up on initial conversations with clinical staff regarding screens and licensure being asked of them
• Assist with the filing, scanning, and documentation of each credentialing processes.
Knowledge of TJC and NCQA Standards and medical terminology. Organizational skills; strong working knowledge of Microsoft Word and Excel; written, proofing and composition skills; Meet deadlines and prioritize tasks.
- HS Diploma or equivalent required, Associates Degree preferred.
- Minimum of 1 (one) year of health care credentialing experience required.
If you feel you are qualified for this position, apply today! It won' t be available long!