Credentialing Assistant

APLA Health•Los Angeles, CA

10d•$25 - $27•Hybrid

About The Position

The Credentialing Assistant reports to the Credentialing Supervisor and supports the daily administrative work involved in provider credentialing. The role assists with credentialing applications and enrollment for medical, behavioral, and dental providers; follows up with health plans; maintains credentialing records and provider information; and helps ensure providers remain enrolled and compliant with health plan requirements. The position is full-time, non-exempt, and hybrid, with onsite work three days per week. Orientation and training must be conducted onsite. The schedule is Monday through Friday, 8:00 a.m. to 5:00 p.m., at the David Geffen Health Center Koreatown in Los Angeles, California. The role requires an associate degree and two years of credentialing or administrative experience, or a high school diploma and four years of experience. Candidates should be organized, detail-oriented, computer savvy, persistent, able to meet deadlines, and effective in oral and written communication. Knowledge of health plan enrollment or prior healthcare experience is preferred. Familiarity with Outlook, Microsoft Word, and Microsoft Excel is expected; Paycom experience is preferred. The position primarily involves office work, daily computer use, and occasional handling of office materials weighing 25 pounds or less. COVID-19 vaccination or a medical or religious exemption is required.

Requirements

Associate degree and two years of credentialing or administrative experience, or a high school diploma and four years of experience.
Organized, computer savvy, and detail-oriented.
Clear and effective oral and written communication skills.
Ability to meet deadlines and persist in following up on work.
Strong organizational skills and attention to detail.
Ability to work with people from diverse cultural, educational, social, and economic backgrounds.
Willingness to learn the credentialing process.
COVID-19 vaccination or a medical or religious exemption is required.

Nice To Haves

Knowledge of health plan enrollment or prior healthcare experience.
Knowledge of Outlook, Microsoft Word, and Microsoft Excel.
Paycom experience.

Responsibilities

Assist with populating provider credentialing applications to expedite submission to health plans.
Assist with credentialing applications for new medical, behavioral, and dental providers.
Contact health plans 15–30 days after submissions to check application status.
Upload credentialing files to Paycom, including approvals, rejections, terminations, and recredentialing records.
Enter effective dates and credentialing status into Paycom.
Record credentialing data in the Health Plan Enrollment spreadsheet, including effective and expiration dates, status information, demographic updates, and terminations.
Notify the Billing & Credentialing work group when health plan applications have been submitted and when providers are fully enrolled in all health plans.
Connect with Clinic Directors quarterly to confirm provider service locations and schedules.
Update provider schedules in the provider information spreadsheet.
Verify quarterly with each health plan that providers are actively credentialed and enrolled.
Complete required health plan portal and directory attestations.
Send health-plan-required trainings and track completion before deadlines.
Submit provider demographic changes, including changes to service location, schedule, leave status, name, and patient acceptance.
Retrieve and upload current health plan rosters quarterly when applicable.
Assist with provider terminations from health plans and update tracker sheets.
Follow up on CAQH matters and upload current documents, including licenses, DEA records, and insurance documents.
Conduct monthly OIG Streamline Verify checks for employees if this task remains within credentialing.
Follow up on annual NP protocols and PA practice agreements.
Follow up on privileging requests for already credentialed providers who need renewals.
Perform other duties as assigned to meet business needs.