What are the responsibilities and job description for the Credentialing Specialist - No Remote position at Cardiovascular Institute of San Diego, Inc.?
We are seeking a highly organized and detail-oriented individual to join our team as a Credentialing Specialist. This role will work directly under the Vice President of Contracts, providing essential support to ensure the accuracy and timeliness of contract management and credentialing processes.
Key Responsibilities:
- Ensure the timely update of hospital and health plan provider directories.
- Process initial and reappointment hospital applications, checking for completeness and accuracy, including primary source verification of confidential and sensitive practitioner information.
- Ensure that all credentials’ files are current and complete pursuant to expiration date of medical licenses, board certification, CAQH, professional-liability insurance coverage, DEA & other pertinent information per bylaws, rules and regulations, and policies and procedures.
- Maintain up-to-date credentialing database (physicians & Mid-Level Staff) with current practitioner information.
- Coordinate with insurance companies, healthcare facilities, and providers for credential updates.
- Track contract renewals, expirations, and any necessary modifications.
- Collaborate with the VP to implement process improvements for contract management and credentialing workflows.
Qualifications:
- Experience and relationships with California health plans credentialing policies and procedures required.
- A solid understanding of the healthcare industry, medical terminology, and credentialing processes.
- Familiar with federal and state regulations, Joint Commission standards, and other accreditation requirements related to credentialing and privileging.
- Strong attention to detail and ability to manage multiple tasks in a fast-paced environment.
- Excellent organizational and communication skills.
- Ability to manage multiple tasks and deadlines efficiently.
- Proficiency in Microsoft Office Suite and familiarity with credentialing software and Excel spreadsheets is a plus.
- Ability to handle confidential information with professionalism and discretion.
Desired
- Previous hospital medical staff or managed care credentialing experience.
- Certified Professional Medical Staff Management (CPMSM) certification.
- Working knowledge of TJC, NCQA, and CMS credentialing and privileging standards and experience with provider and/or health plan credentialing and delegated health plan credentialing audits.
- Bachelor’s Degree preferred.
- Knowledge of health plan and hospital credentialing requirements.
Education
- 3 years professional experience or Professional certification, such as the Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) or actively pursuing certification and certification obtained within one (1) year of eligibility to sit for the exam offered by the National Association Medical Staff Services (NAMSS), is required.
Job Type: Full-time
Pay: From $28.84 per hour
Benefits:
- 401(k)
- Dental insurance
- Free parking
- Health insurance
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift
- Monday to Friday
- Weekends as needed
Education:
- Bachelor's (Preferred)
Experience:
- Credentialing: 1 year (Preferred)
- TJC: 1 year (Preferred)
- NCQA standards: 1 year (Preferred)
License/Certification:
- Certified Provider Credentialing Specialist (CPCS) (Preferred)
- Certified Professional Medical Services Management (CPMSM) (Preferred)
Ability to Commute:
- San Diego, CA 92123 (Required)
Work Location: In person
Salary : $29
