Credentialing Specialist

You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.

Job Summary

Our client is seeking a Credentialing Specialist to optimize revenue cycle billing and collections through efficient processing of provider credentialing and enrollment requirements. This role includes managing a centralized master roster, tracking application lifecycles, and ensuring compliance with all relevant regulations.

Key Responsibilities

• Revenue Cycle Optimization: Process provider credentialing and enrollment requirements within strict timelines.
• Master Roster Management: Maintain and audit a centralized master roster of provider data.
• Application Lifecycle Tracking: Track credentialing, re-credentialing, and enrollment applications.
• Primary Source Verification: Conduct thorough background investigations and verifications.
• Tracking System Design: Manage tracking systems to monitor application statuses and prevent lapses.
• Regulatory Compliance: Ensure compliance with policies, state laws, HIPAA, and accreditation standards.
• Payer & Vendor Relations: Communicate with health plan representatives and vendors regarding applications.
• Cross-Functional Collaboration: Coordinate processes across HR, Accounts Receivable, and Operations.
• Reporting & Analytics: Design reports to support contracting efforts and provide insights.
• Process Improvement: Contribute to process and performance improvements.
• Issue Resolution: Serve as the point of contact for credentialing inquiries and resolve issues.
• Audit Readiness: Assist with credentialing audits and conduct file audits.
• Professional Conduct: Maintain knowledge of health plan requirements and uphold professional ethics.

Qualifications

• Outpatient Credentialing experience.
• Credentialing database experience.
• Bachelor's degree in a related field is preferred.

Experience

• Experience in BH credentialing and hospital settings is preferred.

Skills

• Strong organizational skills and attention to detail.
• Proficiency in credentialing databases and software.

Benefits

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
• Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
• 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
• Short Term Disability Insurance.
• Term Life Insurance Plan.

Hours Per Week

40 hours per week

* We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).


Medix Overview:

With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we're dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.

* As a job position within our Revenue Cycle division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, handling financial and other payment data, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.