Credentialing Specialist - Camino Media

Job Description

Job Description

Clinica Sierra Vista is excited to be one of the largest Federally Qualified Health Centers in the Nation! We’re honored to serve the men and women of the fields. We also offer care and support to the inner city, the rural and isolated, those of low, moderate, and fixed incomes, and families from an array of cultural backgrounds who speak several languages. We don’t inquire about immigration status because we simply don’t need to know. If you come to us, we will treat you like any other patient.

As we grow our team, we are looking for individuals who believe the patient is always #1.

Why work for us?

• Competitive pay which matches your abilities and experience
• Health coverage for you and your family
• Generous number of vacation days per year
• A robust wellness plan and health club discounts
• Continuing education assistance to grow and further your talents
• 403(B) plan with company matching

Intrigued? We’d love to hear from you! Please review the job details below and then click “apply.”

We're looking for someone to join our team as a Credentialing Specialist who:

Initiate, coordinate, monitor and maintain the credentialing and re-credentialing of all practitioners and allied health staff employed and/or contracted with Clinica Sierra Vista. Will also assist to perform duties regarding various managed-care activities.

Essential Functions:

1. Completion of health care professionals credentialing and re-credentialing applications including the privileging and re-privileging for all Practitioners and allied health staff employed/or contracted with Clinica Sierra Vista. In addition, responsible for the completion of the credentialing and re-credentialing of Other Licensed and Certified Practitioners.
2. Initiates and conducts primary source verification of practitioner’s background, education/training and malpractice history through the use of online systems, written correspondence, telephone inquiries and other acceptable credentialing methods.
3. Identifies and evaluates potential red flags and works in collaboration with the credentialing manager to determine next steps.
4. Performs ongoing monthly and quarterly compliance reporting. Analysis of report data and state board sanction information in compliance with regulatory on-going monitoring requirements.
5. Is responsible for preparation of materials and files for presentation and review by credentialing committee.
6. Perform data management and reporting from credentials database.
7. Collaborates with inter-departmental peers, including Quality Management and Operations to identify and implement best practices and to ensure an integral, timely, and consistent product.
8. Works with Human Resources/Operations department/Recruitment to ensure timely credentialing of new health care professionals prior to employment.
9. Issues and coordinates Basic Life Support Trainings for employees
10. Verifies HRSA provider verifications timely and accurately

You'll be successful with the following qualifications:

1. Any combination equivalent to: An associate’s degree AND one year of credentialing experience in a managed care setting or experience in the medical field with a thorough understanding of credentialing and privileging. Background of strong administrative skills will also be considered.
2. Certified Provider Credentialing Special (CPCS) desired.
3. Working knowledge of accreditation standards, including Joint Commission, NCQA, HRSA and CMS preferred.
4. Knowledge of MD Staff (ASM) preferred.
5. Proven ability to function independently with minimal direct supervision required.
6. Strong organizational and communication skills required.
7. Excellent oral and written communication, interpersonal and computer skills required.
8. Proficient in Microsoft Office Suite (Outlook, Word, Excel).
9. Comfortable extracting and formatting data for ad hoc report requests.
10. Attention to detail a must.
11. Confidentiality required.

Clinica Sierra Vista values human rights, goodwill, respect, inclusivity, equality, and recognizes that the organization derives its strength from a rich diversity of thoughts, ideas, and contributions. As leaders in healthcare industry, we aspire to be an employer of choice by promoting an organizational culture that reflects these core values. We seek to attract, develop, and retain a talented and dedicated workforce where people of diverse races, genders, religions, cultures, political affiliations and lifestyles thrive. Our goal is to create a welcoming and inclusive environment that empowers our employees to provide the highest level of service to our community of residents and businesses; they’re counting on us.

Clinica Sierra Vista is an equal opportunity employer and strives to attract qualified applicants from all walks of life without regard to race, color, ethnicity, religion, national origin, age, sex, sexual orientation, gender identity, gender expression, marital status, ancestry, physical disability, mental disability, medical condition, genetic information, military and veteran status, or any other status protected under federal, state and/or local law. We aim to create an environment that celebrates and embraces the diversity of our workforce. We welcome you to join our team!