Credentialing Coordinator Pasadena CA
Salary: 20.00 per Hour – 21.00 per Hour
The Credentialing Coordinator is responsible for the timely gathering, reviewing, and compiling of provider application information to be submitted to the appropriate credentialing service party. Ensures interpretation and compliance with the appropriate credentialing regulations. The Credentialing Coordinator is also responsible for the accuracy and integrity of the CAQH and credentialing tracking databases. Acts as the liaison between the credentialing services and providers/health plans.
- Completes credentialing, re-credentialing and medical staff applications for clinical staff and submits information to commercial and government payors in a timely manner.
Ensures that all provider files are complete with current licensing and certification documents.
- When appropriate, works cooperatively with administrative staff to obtain pertinent information necessary for IPAs.
- Develops thorough understanding of credentialing terminology and documents and is able to utilize external systems used to research and obtain pertinent information.
- Manages provider profiles in practice management system.
Manages IPA coordination for information, and ensures providers are maximized
- Responsible for the timely gathering and submitting for processing to IPAs and health plans on an ongoing basis, all credentialing and re-appointment applications.
- Assist provider on completing credentialing application when necessary.
- Tracks all pending applications and notifies the supervisor of any challenges with obtaining provider information.
- Responsible for reviewing and verifying all credentialing documentation for providers, confirming consistency and accuracy based on regulatory requirements.
- Coordinates review and approval of clean files by the Medical Director.
- Prepares credentialing documentation for the Risk Management and Compliance Committee.
- Prepares credentialing documents for approval from the Medical Director and Credentials Committee
- Assists supervisor with credentialing audits.
- Maintains accuracy and integrity of the CAQH and credentialing tracking databases.
- Maintains provider credentialing files in system and conducts internal file audits to ensure accuracy and efficiency throughout the credentialing process.
Responsible for obtaining monthly reports from IPAs.
- Obtain privileging and competency documentation for clinical staff.
- Works with all related parties necessary on day-to-day credentialing and privileging issues and requests as they arise.
- Performs other related duties as assigned or requested
- High School Diploma or equivalent
- 1-2 years credentialing experience or equivalent combination of education and experience.
- Must be detailed oriented and possess strong organizational skills. Possess effective oral and written communication skills, proficient in the use of Microsoft Office: Word, and Excel
Knowledge of: CAQH preferred.
Work with people of diverse cultural, educational, social, and economic backgrounds. Must possess the ability to follow instructions and exercise good judgment. Ability to thrive in a fast-paced dynamic work environment and meet all deadlines.