Credentialing Specialist
Catalight
- Walnut Creek, CA
- $30.00-35.00 per hour
- Permanent
- Full-time
- Credentialing Program:
- Maintain individual practitioner files to include up-to-date information needed to complete the required governmental and commercial payer credentialing applications.
- Provide coordination to ensure practitioners’ CAQH profiles are up-to-date.
- Maintain practitioner license and certification primary source validations in the data management system.
- Complete credentialing requests from payors and other customers.
- Credential new practitioners and re-credential current practitioners.
- Work closely with the Revenue Cycle Management staff to identify and resolve any denials or authorization issues related to practitioner credentialing.
- Manage user access to the practitioner data management system.
- Other duties as assigned.
- Training and Technical Assistance:
- Provide training and technical assistance to internal and external customers on practitioner credentialing requirements and processes.
- Participate in special projects, and assist with additional duties or tasks, as assigned.
- Department Support
- Monitor queues and assign tickets to appropriate resources for resolution.
- Monitor queues to ensure Service Level Agreements are met.
- Must attend staff meetings, training courses, and other meetings as requested.
- High School Diploma required; bachelor’s degree preferred.
- 2+ years of experience in healthcare administration, with experience in credentialing preferred.
- Sensitivity to working with an ethnically, linguistically, culturally, and economically diverse population.
- A commitment to the values of the organization while demonstrating good judgment, flexibility, patience
- Consistently demonstrate good judgment and decision-making skills while maintaining the highest level of confidentiality.
- Work in an exciting, fast paced high energy environment while effectively multitasking and managing day-to-day responsibilities without supervision.
- Personable; able to work comfortably with individuals at all levels within the organization.
- Must be highly detail oriented.
- Strong interpersonal skills.
- High level of organizational skills and attention to detail.
- Communicate effectively verbally and in writing.
- Strong working relationships and encourage an environment of teamwork.
- Exercise confidentiality and discretion pertaining to the work environment.
- Positive attitude and a willingness to consider creative solutions to challenges.
- Strong ability to plan and prioritize to meet deadlines.
- Consistently demonstrate good judgment and decision-making skills.
- Must be able to communicate effectively within the work environment, read and write using the primary language within the workplace.
- Visual and auditory ability to work with clients, staff and others in the workplace continuously.
- Frequent speaking and listening (25-75%) to clients, staff, and others in the workplace.
- Utilize computer and cell phone for effective communication.
- Ability to obtain and maintain criminal record clearance through the Department of Justice (DOJ). The People & Performance Department must analyze DOJ/FBI live scan reports in accordance with applicable Federal, State, and Local laws, as well as fitness for the position.
- Ability to obtain and maintain clearance through the Office of Inspector General.
- Must attend any required training.
- COVID-19 vaccination and subsequent boosters required for any in office presence at all company locations.