Credentialing Specialist - Pasadena, United States - Imperial Health Plan of California

Description

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People are the most important asset of Imperial_, _for this reason the difference and plurality of people, equality of opportunities, non-discrimination and inclusion in the workplace are priority and strategic factors in the Organization.

Imperial maintains a strong will to promote Diversity, Equity, and Inclusion, through inclusive leadership as a lever change and business sustainability.

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Imperial Health Plan of California, Inc., is licensed by the California Department of Managed Health Care as a health care service plan in accordance with the Knox-Keene Act to provide Medicare Advantage covered services, including a Medicare Advantage Prescription Drug plan, and a Chronic Condition Special needs plan over numerous counties in California.

Through its affiliates, Imperial Insurance Companies, Inc., and Imperial Health Plan of the Southwest, Inc., it also offers individual marketplace covered services in Texas, Utah, Nevada and Arizona.

Mission is to deliver valuable care so that members are healthy in body, mind, and spirit to achieve their inherent potential.


ESSENTIAL JOB FUNCTIONS:

• Identify any adverse actions from provider and document for review.
• Ensures that all provider files are complete with current licensing and certification documents.
• When appropriate, works cooperatively with administrative staff to obtain pertinent information necessary for IPA's.
• Possess thorough understanding of credentialing terminology and documents and is able to utilize external systems used to research and obtain pertinent information.
• Manages provider profiles in practice management system.
• Manages IPA coordination for information, and ensures providers are maximized.
• Responsible for reviewing and verifying all credentialing documentation for providers, confirming consistency and accuracy based on regulatory requirements.
• Coordinates review and approval of clean files by the Medical Director.
• Prepares credentialing documentation for the Risk Management and Compliance Committee.
• Prepares credentialing documents for approval from the Medical Director and Credentialing Committee.

EDUCATION/EXPERIENCE:

• High school graduate or equivalent.
• 5+ years credentialing experience in a hospital, medical staff office or health plan. Strong CAQH and ICE Checklist experience required. Primary Source Verification experience a plus.

SKILLS/KNOWLEDGE/ABILITY:

• Proficient in the use of

Microsoft Office:
Word, and Excel

• Proficient in the use of

Adobe Acrobat


LICENSURE/CERTIFICATE/TRAINING:

• CPCS or CMSC Certificate is a plus

Pay:
$ $29.00 per hour


Benefits:

• 401(k)
• 401(k)

matching

• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Experience:


Microsoft Office: 2 years (required)
Microsoft Excel: 2 years (required)

- credentialing: 2 years (required)


Work Location:
In person