Contract and Credentialing Specialist - Healthcare

PRECISION DIAGNOSTICS • San Diego, CA

3d • $32 - $33 • Onsite

About The Position

Precision Diagnostics, based in San Diego, California is a fast-growing clinical laboratory that specializes in providing drug testing, primarily for the purpose of helping physicians monitor their patient’s undergoing treatment for pain or substance abuse. Precision’s objective is to improve patient adherence/compliance with their prescription regimen, reduce healthcare costs and protect medical practices from liability. We are looking for a Contract & Credentialing Specialist for our Payor Credentialing Department. This role ensures facilities have accurate credentials. Responsibilities include completing initial credentialing, revalidation/recredentialing, and contracting applications at regional and national levels. Key tasks involve 0monitoring license updates, and ensuring compliance with state and federal requirements. The Specialist reports to the Credentialing and Contracting Manager and must know Medicare, Medicaid and Health Plan regulations, standards, and best practices to implement and maintain credentials and managed care contracts. This position requires attention to detail, tracking multiple timelines, and maintaining relationships with payors, internal and external stakeholders.

Requirements

• 3 - 5 years of experience with U.S. healthcare contracting and or credentialing
• Multi-state credentialing experience
• PECOS and Medicaid provider enrollment experience
• Must be able to successfully maintain multiple projects simultaneously, manage and meet multiple deadlines, be detail-oriented, and possess strong organizational skills
• Excellent verbal and written communication skills as well as listening skills and reading and writing comprehension to technical and non-technical audiences of various levels within the organization (e.g., executive, management, individual contributors)
• Ethical conduct and the ability to respect and preserve confidential information entrusted in the course of professional duties is necessary. Reveals confidential information only to appropriate parties and in accordance with any applicable law. Maintains confidentiality regarding legal matters, privacy issues, information technology, and data integrity
• Excellent problem solving, time management, and work prioritization skills
• Ability to establish and maintain positive relationships with internal and external stakeholders and be a team player
• Become fluent in Microsoft 365 applications assigned to your role. Common applications include Teams, Word, Excel, Outlook
• Complete training in a timely manner that is assigned to you. Training is primarily conducted via Microsoft Learn modules and is assigned based on: Position/Job Role – Most positions require a core set of Microsoft 365 working knowledge Project Role – As member of a project team, you may be required to complete training before you can engage with the project team or commence project work Ad-Hoc – Based on review of your performance via support requests, training modules will be assigned to increase skills

Nice To Haves

• Health plan credentialing processing preferred.
• Facility credentialing a plus.

Responsibilities

• Complete Initial, Recredentialing and Contracting applications with 90% accuracy
• Maintain credentialing enrollments to ensure they are current and active
• Manage and respond to emails in the credentialing inbox in a timely manner
• Maintain the credentialing database to ensure credentialing and contracting currency and accuracy
• Communicate with payors, internal and external stakeholders regarding the status of our credentialing and contracts.
• Maintain current payor drug testing policies and procedures
• Maintain and manage payor provider portals and assist internal and external stakeholders with access
• Generate credentialing reports from credentialing database as needed
• Perform other credentialing and contracting duties as requested

Benefits

• Comprehensive benefits package: Medical, Dental, Vision, and additional optional coverages
• 401K with company match
• Paid time off and paid Holidays
• Precision is dedicated to giving back to our communities through various platforms such as: Sponsoring high school students with limited economic means Annual company food drive with Precision matching each employee donation Precision Cares program, partnering with local communities each year to give back
• Frequent company events to keep our employees connected such as: Lab Week: To celebrate and recognize the value our Lab Team members contribute Compliance Week: To shine a light on the importance of compliance & ethics National Sales Meeting in San Diego for all Sales team members to connect and learn

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed