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Credentialing/Contracting Coordinator
등록일 : 11-09-2018 조회수 : 49 관심글

채용정보

지역 : Anaheim/CA
직종 : 일반사무 근무형태 : Full time
경력 : 무관 연봉/급여 : 협의

Credentialing/Contracting Coordinator

 

Description 

Responsible for data entering, gathering, and primary source verification of healthcare practitioner information, including in-depth, detailed, or challenging research of information. Primary methods of researching information include internet, phone, fax, e-mail, and letters. Responsible for expanding/maintaining the provider network through contracting efforts. 

Essential Functions 

- Credentialing 

Contact providers to initiate initial credentialing or re-credentialing 
Update expiring documents such state licenses, DEA licenses, and malpractice insurances 
Manage and organize the credentialing folders and files 
Data entry into the provider database 
Contact providers for follow-up calls 
Assist in the contracting processes; successfully obtain contracts or LOAs from providers 
Create monthly credentialing meeting minutes 
Assist the department with regular health plan audits 
Performs other duties as assigned 


- Contracting 

Obtain contracts and letters of agreement (LOAs) from providers who want to join our network 
Initiate initial credentialing on providers who want to join our network 
Maintain and ensure network adequacy for the IPAs 
Coordinate with other departments to obtain contracts/LOAs with requested providers 
Call/follow-up with providers on a daily/regular basis to obtain contracts/LOAs 
Prepare contracts/LOAs for board signatures 
Negotiate Medicare reimbursement rates with prospective providers 
Assist in provider network audits 

Qualifications 


High school graduate/diploma 
Must be familiar with the credentialing process; with what type of organization/company an MSO is; with health care and managed care; with ICE and NCQA credentialing standards 
Able to follow-up on calls, emails, faxes and obtain results 
Have clear and concise phone and verbal communication skills 
Comfortable being on the phone frequently 
Ability to write legibly 
Demonstrate effective written communication skills 
Have strong computer, typing, and data entry skills: includes MS Word, Excel, and web-based application, internet, and database programs 
Detail oriented with ability to recognize vital information from verification documents 
Possess proof-reading skills sufficient for auditing documents 
Ability to prioritize well and meet overlapping deadlines 
Demonstrates problem-solving, critical thinking, and deductive reasoning skills 
Ability to consistently maintain quality and production expectations 
Benefits 

Monday to Friday 
8:30 AM to 5:30 AM 

Job Type: Full-time

Area : Anaheim

Resume submission: 
info330amm@gmail.com

 

회사 정보

PremierOne Plus MSO