JOB SUMMARY
Responsible for all aspects of the credentialing, and privileging processes for all medical providers who provide patient care at Choice Physicians Network/Choice Medical Group/Horizon Valley Medical Group. Responsible for ensuring providers are credentialed, appointed, and privileged with health plans, hospitals, and patient care facilities as requested.
Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.
Prepare Credentialing files for Credentialing Committee Meeting Agenda, Minutes, and Packets. Responsible for ongoing monitoring and surveillance of all Medical Boards and assists with Audits from the health plan.
QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty to a required standard. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
Knowledge of :
- Federal and state healthcare mandates and regulations
- Company policies and procedures
- Microsoft office applications and use of Excel.
Ability to:
- Problem-solve, negotiate and demonstrate independent decision-making.
- Prioritize with excellent organizational skills, responding to multiple demands and timeliness.
- Demonstrate professional written and verbal communication skills and presentation skills using the English language.
- Demonstrate ability to respond to common inquiries from patients, customers, vendors, regulatory agencies, health plans or member of the business community and possess excellent customer service skills.
EDUCATION and/or EXPERIENCE
High school diploma: or two (2) years related healthcare and/or health plan experience and/or training; or equivalent combination of education and experience. Credentialing Experience highly recommended.
SKILLS
Able to work independently. Excellent verbal and written skills. Computer literate with knowledge of Excel/Word. Relies on experience and judgment to plan and accomplish goals. Performs a variety of tasks. Works under general supervision of the Manager of Credentialing. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
LANGUAGE SKILLS
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or government regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
As an Equal opportunity employer, DBA Choice Medical Group is committed to a diverse workforce. Employment decisions regarding recruitment and selection will be made without discrimination based on race, color, religion, national origin gender, age sexual orientation, physical or mental disability, genetic information or characteristic, gender identity, and expression, veteran status, or other non-job related characteristics or other prohibited grounds specified in applicable federal, state and local laws. In order to ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Era Veterans’ Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact this post for assistance.
For more information about equal employment opportunity protections, please view the ‘EEO is the Law’ poster.
NOTICE: EMPLOYEE POLYGRAPH PROTECTION ACT
YOUR RIGHTS UNDER THE FAMILY AND MEDICAL LEAVE ACT
PAY TRANSPARENCY NONDISCRIMINATION PROVISION
Our environment respects individual differences and recognizes each employee as an integral member of our company. Our workforce reflects these values and celebrates the individuals who make up our growing team.
Choice Medical Group provides a work environment free of harassment and prohibited conduct. We promote and support individual differences and diversity of thoughts and opinion.
Job Type: Full-time
Pay: $20.00 - $25.00 per hour
Benefits:
- 401(k) matching
- AD&D insurance
- Dental insurance
- Disability insurance
- Employee assistance program
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Work Location: In person
