CREDENTIALING ASSOCIATE 1 (2255)

VIVANT HEALTH•Sacramento, CA

7d•$23 - $29

About The Position

With assistance and oversight from senior team members, the Credentialing Associate I is responsible for coordinating, monitoring, and maintaining the credentialing and re-credentialing process. Works with Credentialing Specialist I to ensure interpretation and compliance with the appropriate accrediting while developing and maintaining a working knowledge of the statues and laws relating to credentialing. Responsible for the accuracy and integrity of the credentialing database systems and related applications.

Requirements

Two years of experience in the medical administration industry.
High Volume Data Entry Experience required.
Excellent communication skills, including both oral and written.
Excellent active listening and critical thinking skills.
Ability to solve mid-level problems with minimal supervision.
Ability to demonstrate professionalism, confidence, and sincerity while quickly and positively engaging providers.
Ability to multi-task, exercise excellent time management, and meet multiple deadlines.
Ability to provide and receive constructive job and/or industry related feedback.
Ability to maintain confidentiality and appropriately share information on a need-to-know basis.
Ability to consistently deliver excellent customer service.
Excellent attention to detail and ability to document information accurately.
Ability to effectively and positively work in a dynamic, fast-paced team environment and achieve objectives.
Demonstrate commitment to the organization’s mission.
Must have mid-level skills in Microsoft software (Word, Excel, PowerPoint, Outlook).
Must have the ability to quickly learn and use new software tools.
Must have mid-level skills using e-mail applications.
Self-motivated with strong organizational, multi-tasking, planning, and follow up skills.
Ability to work independently as well as in a team environment.
Ability to present self in a professional manner and represent the Company image.
High School Diploma or GED minimum requirement.

Nice To Haves

Credentialing and Medi-Cal experience preferred.
IntelliSoft system experience preferred.
Associates degree in related field preferred.

Responsibilities

Gathers credentials and re-credentialing materials for contracted providers.
Review and analyze practitioner applications and reapplications, and accompanying documents, ensuring practitioner eligibility.
Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
Prepares credentials file for completion and presentation.
Responds to inquiries from other healthcare organizations.
Assists with managed care delegated credentialing audits; conducts internal file audits.
Monitors the initial process for all Medical/Professional staff and delegated providers.
Ensure compliance with rules, regulations, policies, procedures, and delegated contracts.
Performs related duties consistent with the scope and intent of the position.
Regular attendance.
Travel as required
Enforces Company policies and safety procedures.
Regularly updates job knowledge by participating in educational opportunities, reading professional publications, maintaining professional networks, and participating in professional organizations.
Maintain IPA, Health Plan compliance standards