Credentialing Coordinator
Full Time
Santa Maria, CA 93454
Posted
Job description
Overview
Dignity Health’s Pacific Central Coast Health Centers (PHC) is a non-profit Community clinic organization comprised of more than 40 health centers located primarily from Ventura to Templeton spanning the coast. Our experienced physicians and advanced practice providers offer a wide range of primary and specialty care services. PHC is a part of Dignity Health Central Coast’s award-winning network of outstanding hospitals imaging centers laboratories and post-acute services.
Responsibilities
Job Summary
Qualifications
Experience & Education
Education
Licensure
NA
Dignity Health’s Pacific Central Coast Health Centers (PHC) is a non-profit Community clinic organization comprised of more than 40 health centers located primarily from Ventura to Templeton spanning the coast. Our experienced physicians and advanced practice providers offer a wide range of primary and specialty care services. PHC is a part of Dignity Health Central Coast’s award-winning network of outstanding hospitals imaging centers laboratories and post-acute services.
Responsibilities
Job Summary
Under minimal supervision and by applying expertise and individual judgment, the Credentialing Coordinator is responsible for ensuring the credentialing and payer enrollment and all related credentialing and recredentialing functions, are maintained in accordance with policy and health plan regulatory standards.- The Credentialing Coordinator works in conjunction with the Supervisor, Credentialing/Payer Enrollment, PHC leadership, and Finance in the coordination and implementation of the comprehensive credentialing program.
- The Credentialing Coordinator works closely with the Supervisor, Credentialing/Payer Enrollment to ensure the timely onboarding/enrollment of new providers and the ongoing re-enrollment/revalidation of existing providers.
- The Credentialing Coordinator ensures the organization meets health plan and government regulatory requirements, including functions pertaining to credentialing, credential file auditing, organizational provider credentialing, organizational provider auditing, primary source verification, etc.
- They consult and collaborate with physicians and operational leaders on credentialing related issues and potential credentialing related provider contract terminations.
- The Credentialing Coordinator coordinates/supports PHC and credentialing committees to meet the organizations' bylaws, administrative policies, and health plan contractual requirements.
- They ensure interdepartmental compliance with policies that support onboarding, credentialing, recredentialing, privileging, and network management functions. Manages and has access to provider Protected Personal Information (PPI) and Protected Health Information (PHI) and maintains the confidentiality of the same at all times.
- Must be willing to register for access to confidential government databases, including the notarization of registration documents. Such registration may require providing confidential personal information.
- Occasional other duties as assigned to support Credentialing and Payer Enrollment initiatives and projects.
Qualifications
Experience & Education
- Three years experience in credentialing or closely related health care administration experience.
- Prefer three years prior multi-specialty physician medical group and credentialing experience with health plans.
Education
High School Diploma/GED- A.A. degree preferred
Licensure
NA
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