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Credentialing Coordinator I in Orange at Prospect Medical Systems

Date Posted: 10/16/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    600 City Parkway West
    Orange
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:
    10/16/2018
  • Job ID:
    10867

Job Description



Credentialing Coordinator I

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

This position performs credentialing and re-credentialing activities according to Prospect Medical Credentialing Policies, contracted health plan policies, CMS, DMHC, and NCQA accreditation guidelines. This position acts as a liaison between our IPAs and contracted health plans.



Job Responsibilities/Duties

  • Review all provider credentialing and re-credentialing applications for completeness.
  • Review and analyze credentialing documents, including education, residency and fellowship training, board certification and eligibility, licensure, professional work history, liability insurance, requests for clinical privileges and malpractice history.
  • Assess completeness of information and provider’s qualifications relative to established standards.
  • Determine appropriate verification and reference letters to be prepared for adequate processing of each individual application and reapplication.
  • Identify and flag adverse information from provider application materials for the purpose of conducting special follow-up investigations.
  • Request facility site reviews from appropriate source (i.e. CalOptima) on applicable providers.
  • Responsible for the generating, mailing, tracking, and subsequent processing of provider re- credentialing applications. All re-credentialing files are to be completed within 36 month timeframe. Requires following Prospect Medical policy and compliance schedule for sending up to 3 requests starting 6 months prior to credentialing expiration and making follow up calls according to policy.
  • Update new information as received via re-credentialing process
  • Maintain and exceed quantity and quality goals and standards set by the department
  • Maintain 80% accuracy rate on the number of files submitted for the credentialing committee(s).
  • Responsible for ensuring that Licensing Board Disciplinary Reports are ran and reviewed within a 30 day cycle as required.
  • Review files processed by Credentialing Coordinator(s) prior to committee review.
  • HDO reviews and credentialing.
  • Semi-annual and quarterly reports
  • Additional Responsibilities for Credentialing Coordinator as assigned including assisting with Committees and reporting.


Qualifications

Minimum Education: High school diploma or equivalent.

Minimum Experience: 1 or more (1+) years of experience preferred. Previous credentialing experience with IPA / Medical Group / Hospital experience required. Must be proficient in Excel and Word skills.

Req. Certification/Licensure: None.



Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals you will receive:

  • Company 401K
  • Medical, dental, vision insurance
  • Paid time-off
  • Life insurance


How to Apply

To apply for this role, or search our other openings, please visit http://pmh.com/careers/ and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law: https://www1.eeoc.gov/employers/poster.cfm

Keywords: Credentialing, Credentials, Coordination, Coordinator, Medical Policy, Database Entry, Input Data.



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