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Coordinator, Credentials
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AHMC Healthcare Monterey Park, United StatesOverview: · Monterey Park Hospital, located in San Gabriel Valley of Los Angeles County, and recruiting for a full time **Credentials Coordinator**. Monterey Park Hospital is a 101 bed acute care community hospital and has provided our community with advanced medical and cultural ...
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Credentialing Coordinator
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Keck Medical Center of USC Los Angeles, United StatesThe Credentialing Coordinator is responsible for assuring that the credentialing of practitioners is conducted in accordance with the Office of Integrated Credentialing/client policies and procedures, entity bylaws/credentialing plan, regulatory agencies, and accrediting bodies. ...
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Credentials Coordinator
3 weeks ago
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Credentialing Coordinator
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Advanced Medical Management, Inc. Long Beach, United States**Credentialing Coordinator** · **Role Insights** · This role of a Credentialing Coordinator is considered an essential position within the organization. This individual is responsible for verifying the credentials of our contracted practitioners and ensuring they meet all requir ...
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Credentialing Coordinator
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The Oncology Institute of Hope and Innovation Cerritos, United StatesFounded in 2007, The Oncology Institute of Hope and Innovation (TOI) is advancing oncology by delivering highly specialized, value-based cancer care in the community setting. TOI is dedicated to offering cutting edge, evidence-based cancer care to a population of more than 1.7 mi ...
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Credentialing Coordinator
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Prime Healthcare Management Inc Ontario, United StatesOverview: · Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 45 hospitals and has more than 300 outpatient locations in 14 states providing more than 2.6 million patient visits annually. It is one of the nation's l ...
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Sr Credentialing Coordinator
3 weeks ago
Prospect Medical Holdings Orange, United StatesJob Description · The Credentialing Department provides Credentialing services for practitioners affiliated with Prospect Medical. The Sr. Credentialing Coordinator position performs credentialing and re-credentialing activities according to Prospect Medical Credentialing polici ...
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Sr Credentialing Coordinator
3 weeks ago
Alta Hospitals Orange, United StatesThe Credentialing Department provides Credentialing services for practitioners affiliated with Prospect Medical. The Sr. Credentialing Coordinator position performs credentialing and re-credentialing activities according to Prospect Medical Credentialing policies, contracted heal ...
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Sr Credentialing Coordinator
3 weeks ago
Prospect Medical Holdings Orange, United StatesJob Description · The Credentialing Department provides Credentialing services for practitioners affiliated with Prospect Medical. The Sr. Credentialing Coordinator position performs credentialing and re-credentialing activities according to Prospect Medical Credentialing polici ...
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Healthcare Credentialing Coordinator
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La Healthcare & Professional Inc Rosemead, United States**Benefits/Perks** · - Competitive Compensation · - Great Work Environment · - Career Advancement Opportunities · **Job Summary** · **Responsibilities** · - Maintain accurate records of all credentials and licensing information for all providers · - Organize and keep copies of al ...
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Credentialing Coordinator
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Lee Hecht Harrison Nederland B.V. Brea, United StatesThe Credentialing Coordinator's primary responsibility is to oversee and complete credentialing applications for both initial appointments and re-credentialing for all licensed providers. Additionally, the Credentialing Coordinator is responsible for keeping all relevant stakehol ...
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Credentialing Coordinator
2 weeks ago
Lee Hecht Harrison Nederland B.V. Brea, United StatesThe Credentialing Coordinators primary responsibility is to oversee and complete credentialing applications for both initial appointments and re-credentialing for all licensed providers. Additionally, the Credentialing Coordinator is responsible for keeping all relevant stakehold ...
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Credentialing Coordinator
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LHH Recruitment Solutions Brea, United StatesJob Description · Job DescriptionThe Credentialing Coordinator's primary responsibility is to oversee and complete credentialing applications for both initial appointments and re-credentialing for all licensed providers. Additionally, the Credentialing Coordinator is responsible ...
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Credentialing Coordinator
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The Oncology Institute of Hope and Innovation Cerritos, United StatesFounded in 2007, The Oncology Institute of Hope and Innovation (TOI) is advancing oncology by delivering highly specialized, value-based cancer care in the community setting. TOI is dedicated to offering cutting edge, evidence-based cancer care to a population of more than 1.7 mi ...
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Credentialing Coordinator
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AltaMed Health Services Montebello, United StatesWork Boldly. Live Brilliantly. · At AltaMed, we don't just serve our communities, we are part of them. We have raised the expectations of what a community clinic can deliver because we think quality care is for everyone. And, we are determined to provide it no matter the challen ...
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credentialing coordinator
1 week ago
AHMC Healthcare Alhambra, United StatesOverview: · Primary Function · Responsible for the effective function and coordination of the credentialing and re-credentialing process and other assigned tasks. Coordinates with physicians, external agencies, administration, nursing department, risk management / performance i ...
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Credentials Coordinator
3 weeks ago
Riverside Community Hospital Riverside, United StatesDescription · Hourly Wage Estimate: $ $41.56 / hour · Learn more about the benefits offered for this job. · The estimate displayed represents the typical wage range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, ...
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Credentialing Coordinator
3 weeks ago
AltaMed Health Services Montebello, United StatesWork Boldly. Live Brilliantly. · At AltaMed, we don't just serve our communities, we are part of them. We have raised the expectations of what a community clinic can deliver because we think quality care is for everyone. And, we are determined to provide it no matter the challen ...
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Credentialing Coordinator
1 week ago
The Oncology Institute of Hope and Innovation Cerritos, United StatesJob Description · Job DescriptionFounded in 2007, The Oncology Institute of Hope and Innovation (TOI) is advancing oncology by delivering highly specialized, value-based cancer care in the community setting. TOI is dedicated to offering cutting edge, evidence-based cancer care to ...
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Credentialing Coordinator
2 weeks ago
The Oncology Institute of Hope and Innovation Cerritos, United StatesFounded in 2007, The Oncology Institute of Hope and Innovation (TOI) is advancing oncology by delivering highly specialized, value-based cancer care in the community setting. TOI is dedicated to offering cutting edge, evidence-based cancer care to a population of more than 1.7 mi ...
Sr Credentialing Coordinator - Orange, United States - Prospect Medical Holdings
Description
Job DescriptionThe Credentialing Department provides Credentialing services for practitioners affiliated with Prospect Medical. The Sr.Credentialing Coordinator position performs credentialing and re-credentialing activities according to Prospect Medical Credentialing policies, contracted health plan policies, CMS, state law, and NCQA accreditation guidelines.
This position acts as a liaison between our IPAs and contracted health plans to perform any credentialing needs as needed.
ResponsibilitiesReview practitioner and organizational provider credentialing and re-credentialing applications for completeness.Review and analyze credentialing documents, including education, residency and fellowship training, board certification and eligibility, licensure, professional work history, liability insurance, requests for clinical privileges, malpractice history, and accreditation.
Assess completeness of information and provider's qualifications relative to established standards.Determine appropriate verification and reference letters to be prepared for adequate processing of each individual application and reapplication.
Identify and flag adverse information from provider application materials for the purpose of conducting follow-up investigations.
Request facility site reviews from appropriate sources (i.e. CalOptima) on applicable providers.
Responsible for completion of re-credentialing files within a 36-month timeframe.
Update new information as received via re-credentialing process.
Maintain and exceed quantity and quality goals and standards set by the department.
Lead role in ensuring that Ongoing Monitoring Reports are reviewed within a 30-day cycle as required and that all required steps are taken and attested to by monitored providers.
Lead role in responding to all health plan ongoing monitoring inquiries in a timely manner.Perform self-audits on all files processed prior to QA review.
Prepare summary packets for Credentialing Committee review on all files not meeting the Clean File Criteria.
Semi-annual and quarterly reports.
Additional Responsibilities for Credentialing Coordinator as assigned including assisting with Committees and reporting.
Obtain and verify expired documents including licensure, board certification, and liability insurance.
Support training of new staff members.
Utilize system reporting to identify areas for improvement and work with the Credentialing Manager and Trainer to establish new/updated policies and procedures.
Lead credentialing projects to ensure timeliness of application processing, system data integrity, and compliance with all required standards, policies, and laws.
Demonstrate and maintain credentialing knowledge. Keep abreast of new and changing regulations and standards.Follow and abide by departments Policies and ProceduresOther duties as assigned.
QualificationsMinimum Education:
High school diploma or equivalent
Minimum Experience:
2-5 years of experience in credentialing. Requires a dynamic person with the ability to work in a fast-paced environment. Excellent written/verbal and organization skills required. Must be proficient in Excel and Word skills. Preferred proficiency in Adobe Acrobat Professional. Must be highly organized with excellent attention to detail and clerical accuracy. Must be self-motivated with the ability to complete projects independently within established timeframes. Previous credentialing experience with IPA/Medical Group utilizing NCQA standards preferred.
Req.
Certification/Licensure:
NONE.About UsWith approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Texas and Rhode Island.
Our extensive care services range from primary care and specialty physician services to acute care hospital and skilled nursing facilities to behavioral health and wellness services.
Each of our Independent Physician Associations (IPAs) and networks support the use of advanced diagnostic and treatment tools to provide our members with convenient access to state-of-the-art healthcare.
For 25+ years, Prospect Medical has been focused on our mission of supporting independent physicians where, through risk arrangements, we work closely together with health plans, facilities and healthcare physicians for the benefit of every person who comes to us for care.
We provide quality healthcare services that are designed to offer our patients highly coordinated, personalized care and that help them live healthier lives.
Prospect Medical Systems manages highly successful IPAs by leveraging our best-practices, results-driven administrative services to manage patients under risk arrangements with health plans/CMS.
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