Medical Credentialing Specialist

Imperial Health is hiring a credentialing specialist

This is an on-site role in Pasadena

The Credentialing Specialist 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. 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.

1. Completes credentialing, re-credentialing, and medical staff applications for clinical staff and submits information to commercial and government payors in a timely manner

2. Ensures that all provider files are complete with current licensing and certification documents

3. When appropriate, works cooperatively with administrative staff to obtain pertinent information necessary for IPA's

4. Develops a thorough understanding of credentialing terminology and documents and is able to utilize external systems used to research and obtain pertinent information

5. Manages provider profiles in the practice management system

6. Manages IPA coordination for information, and ensures providers are maximized

7. Responsible for the timely gathering and submitting for processing to IPA’s and health plans on an ongoing basis, all credentialing and re-appointment applications

8. Assist provider on completing credentialing application when necessary

9. Tracks all pending applications and notifies the supervisor of any challenges with obtaining provider information

10. Responsible for reviewing and verifying all credentialing documentation for providers, confirming consistency and accuracy based on regulatory requirements

11. Coordinates review and approval of clean files by the Medical Director

12. Prepares credentialing documentation for the Risk Management and Compliance Committee

POSITION REQUIREMENTS:

• 2 years of credentialing experience or equivalent combination of education and experience

Job Type: Full-time

Pay: $27.00 - $29.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift

Application Question(s):

• Do you have experience with medical provider credentialing?

Shift availability:

• Day Shift (Required)

Ability to Commute:

• Pasadena, CA 91101 (Required)

Ability to Relocate:

• Pasadena, CA 91101: Relocate before starting work (Required)

Work Location: In person

Salary : $27 - $29