6 Credentialing Audit Specialist Jobs in Los Angeles, CA
MEDPOINT MANAGEMENT is Hiring a Credentialing Audit Specialist Near Los Angeles, CA
Job Description
Salary Range: $24 - $27/ hour
Summary
Responsible for assisting with tasks to ensure that all files and processes are in accordance with NCQA (and other regulatory agency) credentialing standards and regulations. Assists Lead Credentialing Auditor prepares documents timely for onsite and virtual audits.
Duties and Responsibilities
1. Coordinates all activities related to network credentialing including, but not limited to application completeness and maintenance
2. Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up
3. Oversees preparation of credentials files for completion and presentation to MedPOINT’s Credentialing Committee.
4. Responds to inquiries from health plans and provider offices/clinics; interfaces with internal and external customers on day-to-day credentialing issues as they arise.
5. Optimizes efficiency with document generation and reporting
6. Coordinates primary source verification process with Gemini Diversified Services (CVO)
7. Enters primary source documentation in home grown credentialing database
8. Participates in credentialing committee meetings (monthly and ad hoc)
9. Assists with P & P Development in accordance with NCQA & JACHO guidelines
10. Prepares and submits all corrective action plans
11. Performs miscellaneous job-related duties as assigned and requested
Minimum Job Requirements
High school diploma or GED; at least 2 years experience with hospital medical staff or managed care credentialing. NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS) or actively pursuing the above certification highly preferred.
Skill and Abilities
· Strong written and oral communication skills.
· Excellent presentation and analytical skills.
· Knowledge of medical credentialing and privileging procedures and standards.
· Ability to analyze, interpret and prepare reports.
· Proficiency with Microsoft Office Programs; primarily Word and Excel 2013 or higher
· Knowledge of all aspects of credentialing including HDO Credentialing
· Ability to multitask and work well as a team
· Proficient in using credentialing software and databases for data entry and maintenance.
· EZ-CAP® knowledge a plus.
Job Summary
Full Time
$69k-84k (estimate)
06/19/2024
07/08/2024
medpointmanagement.com
WOODLAND HILLS, CA
25 - 50
1988
SHELDON LEWENFUFF PREIDENT
$10M - $50M
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About MEDPOINT MANAGEMENT
MedPoint Management provides IPA management, development and consulting services as well as comprehensive claims processing, medical affairs and financial operations. Clients receive the services of a large medical system in a smaller, more personal setting. MedPOINT Management, Inc. (MPM) provides all aspects of managed care management services to Independent Practice Associations (IPAs) and hospital clients. Our customized management approach meets the unique needs of each of our clients which allows us to successfully manage smaller groups comprised of single physician practices along with ...large groups of FQHC clinics and all practice models in between. Our experienced and knowledgeable staff provides a consistently high level of healthcare management services and strategies. Innovation and commitment to high quality, cost-effective care contribute to the overall satisfaction of our clients and members. Founded in 1987, MedPOINT currently represents a client base of over 4,000 contracted providers throughout California. Our managed IPAs are responsible for coordinating care for over 950,000 members in multiple contracted health plans. The contracts represent various payer mixes including Commercial HMO/PPO, Medi-Cal, Covered California (Exchange), Medicare Advantage and Medi-Medi including CalMedi Connect product lines. Understanding the power of information, MPM has made a significant investment in sophisticated IT systems enabling our management, clinical and administrative staff to efficiently work to coordinate high quality, cost effective, integrated care. The ability to readily track and trend utilization and quality metrics has been a vital component in improving overall health management, impacting the delivery of chronic and episodic care, yielding favorable health outcomes, and assisting our provider networks to meet or exceed health plan benchmarks for HEDIS, STARs and P4P programs. MedPOINTs full range of services are consistently delivered with the same high quality standards that has built our reputation. Flexibility, innovation and an openness to change are what the future demands of us as the nation moves into a new era of Health Care reform. The services MPM is delivering today will continue to embrace these notions to add value to our current and future client base.
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