Managed Care Credentialing Coordinator

Northeast Community Clinic•Alhambra, CA

8d•Hybrid

About The Position

This position is responsible for managing, maintaining, and updating files for all credentialing applications. The role involves processing credentialing and recredentialing applications accurately and in a timely manner. The coordinator will also liaise with medical office staff, licensing/regulatory agencies, and insurance carriers to ensure Quality Assurance compliance.

Requirements

Microsoft Office/Word/Excel/Outlook
Excellent Communication Skills
Excellent Customer Service Skills
Ability to work as a team player and work independently
Reliable transportation
Must be able to travel from facility to facility
AA Degree or higher, experience may substitute for education
1-2 year minimum experience in healthcare administrative support
Familiar with Managed Care Programs and Knowledge of Credentialing Process
Commitment to goals and philosophy of Northeast Community Clinic
Valid State Identification

Nice To Haves

Bi-lingual Spanish/English

Responsibilities

Facilitate initial credentialing, on-going monitoring and re-credentialing process of all Providers in accordance with the National Committee for Quality Assurance standards.
Maintain and update database for provider credentialing, including applications and all other related documents, such as California Medical license, DEA registration, NPI number, Medical School Diploma.
Communicates with internal departments to assess addition and removal of providers onto NECC malpractice insurance; process renewal of malpractice insurance on a yearly basis.
Complete California Participating Physician Application for all new providers and submit to IPA/Health Plans Credentialing Committee for approval; provide IPA/Health Plans with any additional Provider data, as requested.
Serve as point of contact for IPAs; responsible for advising IPAs of all Provider changes and/or updates, including: demographic changes, clinic assignments, new Providers and release of existing Providers.
Update IPAs of all Providers’ renewed licenses (Medical licenses, DEA registration, etc.).
Process Hospital Privileges Application for providers, as advised by Operations Director.
Responsible for completing all Health Plan/IPA and questionnaires.
Prepare and submit verification letters.
Provide status reports as requested.
Handle confidential information in an appropriate manner.
Attend meetings and seminars, as necessary.
Maintain a positive working relationship with staff.
Serves as the Licensing/Certifications Department back up.
Other duties as designated by Operations Director or Executive Director