- Coordinate the medical/dental provider enrollments into all insurance plans.
- Manage credentialing and re-credentialing processes along with completing applications for respective medical/dental commercial, Medicare, and Medi-Cal plans.
- Monitor provider applications for timely approval and follow-up as needed.
- Responsible for all necessary updates including, but not limited to address changes, NPI updates, phone number updates, etc.
- Maintaining knowledge of current requirements with medical/dental plans for credentialing providers.
- Manage and maintain PAVEs portal, Availity, CAQH and other required plan portals.
- Manage and maintain vendor, insurance portal and EpicCare Link accounts (Community Hospitals, Valley Children's and Saint Agnes). This includes providing login information to appropriate staff, removing staff, etc.
- Serve as a delegate for provider applications and review the completed application for accuracy.
- Provide plan roster updates to plans, as needed.
- High School Diploma; AA preferred.
- 2-3 years' experience in Managed Care Credentialing, Medi-Cal, and commercial plan provider enrollment.
- 2-3 years' experience with medical and dental insurance plans.
- Proficiency in typing, filing, medical terminology, and word processing.
- Knowledge of health insurance plans with the ability to navigate web portals.
- A valid California Driver's License and clean driving record with the ability to be insured under CVIH's automobile insurance.
- An awareness and keen appreciation of, or willingness to learn, Indian traditions, customs and socioeconomic needs. Ability to meet and deal effectively with Indian health organizations consisting of numerous tribes with varied cultures. Tact, courtesy, discretion, resourcefulness, and good judgment in handling functions of a sensitive nature.
- "Safety Sensitive" positions are subject to random drug testing and are required as a condition of continued employment.
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Credentialing Enrollment Specialist - Clovis, United States - Central Valley Indian Health
Description
Central Valley Indian Health, Inc. (CVIH) is seeking qualified candidates for the position of Credentialing Enrollment Specialist. The incumbent will be responsible for coordinating, monitoring, and maintaining the credentialing and re-credentialing process in medical and dental insurance plans, including but not limited to Medi-Cal, Medi-Cal Managed Care, Medicare, and commercial insurance. This position will also manage staff access to various provider portals required by those plans. This is a "Safety Sensitive" position and responsible for HIPAA compliance.
PRIMARY RESPONSIBILITIES:
Candidates must submit the Central Valley Indian Health employment application in order to be considered for the position.
