Credentialing Coordinator III

Quick Facts

• Role: Credentialing Coordinator III
• Work location: Eligible to work from home within California
• Schedule: Full-time, Monday–Friday (40 hours/week)

Description

Responsible for completion of credentialing functions to ensure program integrity and compliance with standards, federal/state requirements, and health plan credentialing requirements. Audits Credentialing Verification Organization (CVO) released files to ensure primary source verification of required physician information. Maintains a database of current and accurate information for physicians, contracted providers, and Allied Health Professionals, including licensure, board certification, and professional liability coverage and claims.

Responsibilities

• Ensure credentialing compliance with program standards and federal/state requirements
• Maintain relationships with health plan auditors
• Communicate and work with physician leaders on credentialing issues
• Audit CVO released files to confirm primary source verification of required information
• Maintain and update credentialing database (licensure, board certification, professional liability coverage and claims)

Requirements

• HS Diploma or GED
• 2 years of recent relevant experience
• Knowledge of medical provider credentialing and accreditation principles, processes, procedures, and documentation
• Knowledge of computer spreadsheets and related applications
• Ability to use independent judgment and manage confidential information
• PC skills: MS Word, MS Excel, MS Access; strong data entry skills
• Organizational skills to prioritize, problem-solve, and meet deadlines
• Ability to analyze, interpret, and draw inferences from research findings; prepare reports
• Ability to analyze data/reports and make recommendations

Benefits

Benefits available.