Senior Credentialing Specialist

Description

Who We Are:

Platinum Dermatology Partners is a network of high-quality dermatology clinics that focus on collaborative and innovative ideas to drive growth. We offer general dermatology, cosmetic, medical, plastic surgery, and cancer screening treatments. We have over 145 clinics, over 350 providers, and more than 2200 employees in clinics across Texas, Arizona, California, Nevada, and Florida. We are a rapidly growing company that allows our doctors to focus on providing exceptional care without worrying about the operational side of the business. Our core values focus on collaboration, ownership, respect, excellence, authenticity, and integrity. Our purpose is to empower the practice of exceptional dermatology.

Company Conformance Statements:

In the performance of their respective tasks and duties, all employees are expected to conform to the following:

• Perform quality work within deadlines with or without direct supervision.
• Interact professionally with other employees, customers, and suppliers.
• Work effectively as a team contributor on all assignments.
• Work independently while understanding the necessity for communicating and coordinating work efforts with other employees and organizations.

Position Purpose: ​Overseeing the credentialing and re-credentialing of physicians, mid-level practitioners, and organizational providers is a critical function that ensures healthcare professionals meet established standards for delivering quality care.

Responsibilities/Duties/Functions/Tasks: 

1. Credentialing and Re-credentialing Process

• Verification of Qualifications
  • Conduct thorough investigations into applicants' backgrounds, education, and experience. This includes verifying information through online systems, written correspondence, and direct inquiries.​
• Consistent Documentation
  • Ensure all credentialing applications are processed timely, with complete and accurate documentation.​
• Utilization of Credentialing Databases
  •  Maintain and manage credentialing databases like Modio Health and Assured to streamline the verification process.​

2. Collaboration and Communication

• Interdepartmental Coordination
  • Work closely with health plans and various departments on network expansion, large claims, contract amendments, and related initiatives.​
• Problem Resolution
  • Address and resolve issues with payors related to credentialing, ensuring clear communication with management and clients to maintain satisfaction.​

3. Compliance and Policy Management

• Regulatory Adherence  
  • Stay updated with standards set by accrediting bodies such as the National Committee for Quality Assurance (NCQA) and The Joint Commission to ensure compliance.​
• Policy Development
  • ​​​​​​​Review and update credentialing program descriptions, policies, and procedures to align with current regulations and best practices.​

4. Process Improvement

• Efficiency Enhancement
  • ​​​​​​​Identify opportunities to decrease costs, improve quality, and increase efficiency within the credentialing department.​
• Automation Integration
  • ​​​​​​​​​​​​​​Implement automated solutions to streamline credentialing tasks, reducing manual errors and accelerating the process.

By effectively managing these responsibilities, the credentialing process not only ensures that healthcare providers are qualified and competent but also supports the organization's operational efficiency and compliance with regulatory standards.​

Qualifications

Education:

• High School Diploma or GED is required.
• Bachelor’s degree in a related field or equivalent experience is required.

Qualifications:

• Minimum of 4 years of credentialing and provider contracting experience is required.
• Experience in a managed care and insurance environment is required.
• Minimum of 4 years working in a healthcare environment is required. 

Performance Requirements: 

• Critical analytical thinking, problem-solving, organization, and time management skills with strong attention to detail.
• Adept to regulatory private, federal & state guidelines
• Knowledge and understanding of a multi-tax ID business model
• Knowledge and understanding of contracting within California payor networks
• Advanced MS Office & credentialing software (Modio/Assured) experience is preferred
• Excellent administrative, analytical, organizational, verbal, and written communication and presentation skills are required
• Knowledge of clinic and company policies and procedures
• Knowledge of medical terminology and insurance practices relating to specialist providers
• Knowledge of managed care, Medicare, and Medicaid guidelines
• Ability to work effectively as a team member with physicians and other staff
• Ability to respond appropriately and timely to changing demands
• Assist with credentialing physicians and mid-level providers in other states as needed

Our competitive benefits package includes the following:

• Medical, Dental, and Vision insurance
• Short-term/Long-term disability
• Life and other voluntary plans
• 401(k) plan
• Employee Referral Program
• Paid Time-Off
• Company-Paid Holidays

Equipment Operated: Standard office equipment including computers, fax machines, copiers, printers, telephones, etc.

Physical Requirements: Must possess manual dexterity to operate office machines including computer and calculator; stooping and bending to handle files and supplies; and mobility to complete errands or deliveries. Includes handling of sharps and chemicals.

Equal Employment Opportunity:

Platinum Dermatology Partners is committed to a policy of equal employment opportunities for applicants and Employees. Employment decisions will comply with all applicable laws prohibiting discrimination in employment, including Title VII of the Civil Rights Act of 1964, The Age Discrimination in Employment Act of 1967, the Americans with Disabilities Act of 1990, the Immigration and Nationality Act, the California Fair Employment and Housing Act, and all other applicable state and federal laws.

Platinum Dermatology Partners does not permit discrimination of any type against an employee because of any of the following legally protected characteristics: gender, race, color, religion, country of origin, mental disability, physical disability, marital status, gender identity, gender expression, ancestry, genetic information, medical condition, age, sexual orientation, or pregnancy.

Please note, that any offer of employment is contingent on the successful completion of pre-employment background checks.

No phone calls or agencies, please.