Credentialing & Provider Enrollment Specialist - Posting #20550
Sea Mar Community Health Centers seeks an experienced Credentialing & Provider Enrollment Specialist. This is a Full-time position (Monday-Friday) 8:00 am to 5:00 pm. The Credentialing Specialist be responsible for coordinating all aspects of the privileging and credentialing process for the licensed independent practitioners (LIPs) in accordance with the Policies & Procedures, national standards and regulatory requirements.
Duties and Responsibilities:
- Maintain regular cooperation and compliance with all regulatory, accrediting, and membership-based organizations.
- Create and carry out various credentialing processes in relation to licensed providers in medical, dental and behavioral health departments.
- Ensure that all credentialed providers adhere to facility and staff policies, department guidelines, regulations, and government laws.
- Process applications and reappointment paperwork, checking for full completeness and accuracy.
- Perform provider credentialing/qualifying process to ensure all requirements are met in accordance with credentialing requirements prior to presentation to Board of Directors.
- Ensure that all credential files are current and complete pursuant to expiration date of medical licenses, board certification, professional-liability insurance coverage, DEA and other pertinent information, per HPP and/or client facility policy and procedures.
- Coordinate credentialing process by entering/logging/scanning information into MD Staff credentialing software for initial, updating, and add on applications and maintenance processes.
- Collect and verify sensitive provider data through confidential sources.
- Maintain timely updates to information systems and regular reports used to monitor completion of initial and reappointment credentialing applications.
- Audit files based on internal standards and regulatory requirements.
- Monitor and report application status and provide appropriate correspondence (form letters) to providers and department heads when necessary.
- Provide complete and accurate credentialing files to Administration for inclusion in Board of Directors’ materials.
- Working knowledge of Joint Commission, NCQA and CMS credentialing and privileging standards and experience with provider and health plan credentialing.
- Intermediate computer skills including Microsoft products and web based queries.
- Demonstrated ability to manage and meet multiple priorities and competing deadlines, problem solving and organization skills with attention to details. Experience with credentialing software is desirable, MD Staff preferred.
- Current NAMSS Certified Provider Credentialing Specialist (CPCS) or actively pursuing certification and certification obtained within 2 years of hire date.
- Previous work experience in managed care, hospital or medical office environment required.
- Experience with delegated health plan credentialing agreements preferred.
Sea Mar offers talented and motivated people the opportunity to work in a dynamic and growing community health organization. Working at Sea Mar Community Health Centers is more than just a job, it’s a fulfilling career with opportunity for advancement. The fringe benefits surpass most companies. For example, employees Full-time employees working 30 hours or more, receive an excellent benefit package of Medical, Dental, Vision, Life Insurance, Prescription coverage, Long Term Disability, EAP (Employee Assistance Program), paid-time-off starting at 24 days per year + 10 paid Holidays. We offer 401(k)/Retirement options and an exciting opportunity to work in a culturally diverse environment.
How to Apply:
To apply for this position, complete the online application and click SUBMIT or APPLY NOW. If you have any questions regarding the position, email Letriana Santiago, Credentialing and Provider Enrollment Supervisor at LetrianaSantiago@seamarchc.org
Sea Mar is an Equal Opportunity Employer
Please visit our website to learn more about Sea Mar at www.seamar.org. Follow us on Facebook, Twitter, and Instagram
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