Credentialing Enrollment Specialist

Description

Central Valley Indian Health, Inc. (CVIH) is seeking an organized and experienced Credentialing Enrollment Specialist. This position is responsible for coordinating provider credentialing and re-credentialing activities for medical and dental insurance plans, managing access to provider portals, and ensuring compliance with HIPAA. Supports provider enrollment, maintains accurate records, and collaborates with providers, insurance carriers, and internal teams to facilitate efficient credentialing processes.

PRIMARY RESPONSIBILITIES:

A. Coordinate the medical/dental provider enrollments into all insurance plans.


B. Manage credentialing and re-credentialing processes along with completing applications for respective medical/dental commercial, Medicare, and Medi-Cal plans.


C. Monitor provider applications for timely approval and follow-up as needed.


D. Responsible for all necessary updates including, but not limited to address changes, NPI updates, phone number updates, etc.

E. Maintaining knowledge of current requirements with medical/dental plans for credentialing providers.

F. Manage and maintain PAVE, Availity, CAQH and other required plan portals.


G. Manage and maintain vendor, insurance portal, CAIR and EpicCare Link accounts (Community Hospitals, Valley Children's & Saint Agnes). This includes providing login information to appropriate staff, removing staff, etc.


H. Serve as a delegate for provider applications and review completed application for accuracy.


I. Provide plan roster updates to plans, as needed.


J. Communicate in a friendly and professional manner to others. Provide excellent service/support to all patients, employees, and outside contacts.

K. Any other duties assigned to the employee by the direct supervisor or CVIH Administration.

Requirements

1. High School Diploma required; AA preferred.

2. 2-3 years' experience in Managed Care Credentialing, Medi-Cal, and commercial plan provider enrollment.


3. 2-3 years' experience with medical and dental insurance plans.

4. Proficiency in typing, filing, medical terminology, and the Microsoft Suite.


5. Knowledge of health insurance plans with the ability to navigate web portals, and familiarity with CAQH, PECOS, Medi-Cal, Medicare, and commercial payer enrollment processes preferred.

6. Ability to sit for prolonged periods of time.


7. Strong organizational skills and attention to detail required.

8. Excellent verbal and written communication skills required.

9. An awareness and keen appreciation of, or willingness to learn, Indian traditions, customs and socioeconomic needs. Ability to meet and deal effectively with Indian health organizations consisting of numerous tribes with varied cultures. Tact, courtesy, discretion, resourcefulness, and good judgment in handling functions of a sensitive nature.

CVIH is an equal opportunity employer; however, preference in hiring is given to qualified Native American Indians in accordance with the Indian Preference Act (Title 25 U.S. Code, Section 472 and 473). Applicants claiming Indian preference must submit verification of Indian descent certified by tribe of affiliation or other acceptable documentation of Indian heritage. Qualified Veterans must submit form DD214 "Honorable Discharge". A copy must be attached with application.

Candidates must submit the Central Valley Indian Health employment application in order to be considered for the position.