Credentialing Coordinator (289) (Human Resources)
Kings View is a nonprofit leader in providing behavioral health services to the underserved community, is currently seeking a driven Credentialing Coordinator to join our mission to provide compassionate services to those with limited resources. Our ideal candidate will have a passion to promote social justice and societal awareness, respect for human dignity, and lead with integrity while listening and responding to the community in need.
Credentialing Coordinator (289)
Fresno, CA
Under the direction of the Director of Quality and Performance Improvement, the Credentialing Coordinator is responsible for coordinating, monitoring, and performing the credentials verification process for initial appointments and reappointments of physicians and allied health professionals. Incumbent will develop skills in all aspects of initial comprehensive credentialing and privileging to include reappointment process, requests in accordance with NCQA, DMHC and accreditation standards, state and federal regulatory requirements, bylaws, rules and regulations, policies, and procedures. The Credentialing Specialist serves as a liaison to delegated entities and vendors to ensure current and adequate credentialing processes are in place.
How will I contribute
Develop and perform queries for data reporting purposes to include directories, hoc reports, and network management reports. Responsible for the maintenance of the provider database and providing provider-related reports to internal and external entities. Verify competence, medical and/or professional education, residency, internships, fellowships, additional formal training, relevant board certifications, health care affiliations, work history, military experiences, professional references, licensure and certifications, DEA certificates, malpractice coverage and privileges the applicant is requesting. Identify discrepancies in information and conduct follow-ups. Perform queries of the National Practitioner Data Bank as appropriate. Manage expireables as appropriate. Assist in research and defining criteria for new technology and privileges to present to department Committees for appropriate review and approval. Assist in annual review and updating rules and regulations, policies, and procedures. Process and maintain changes to staff status, ensure the currency and accuracy of all information. Ensure support, maintenance, and updating of the credentialing database system to include credentialing and other database systems as appropriate. Provide quality and ethical customer service to all practitioners, medical group liaisons, and other healthcare entities/partners. Facilitate meetings with program leadership on needs of program for credentialing, as needed. Facilitate training for Staff or Leadership on credentialing, as needed. Send and collect credentialing applications and reapplications. Maintain credentialing reports with contracted Health Plans/entities. Complete health plan provider profiles. Manage provider credential hard and electronic files. Ensure compliance with applicable laws, regulations, procedures, and policies. Performs other duties as assigned.
What I bring
Highschool Diploma (or Equivalent) Class C Driving License2 years of credentialing experience in healthcare, including Managed Care experience, database management, and provider credentialing/enrollment. Knowledge of medical credentialing and privileging procedures and standards. CAQH, NCQA Standards, DMHC Standards.Excellent written and verbal communication skills, Excellent analytical skills, Ability to exercise sound judgement. Thorough understanding of Managed Care principles, and models. Proficient with Microsoft Office Word and Excel.Demonstrates professional behavior towards customers. Attention to detail. Ability to focus for extended periods of time. Must demonstrate and promote a positive team-oriented environment. Work independently, prioritize work activities and use time efficiently.Associate degree preferred. NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS).
The Benefits
Medical, Dental, Vision Insurance Life and Long-Term Disability Insurance 401k plan Vacation time Twelve (12) Paid Holidays Education Reimbursement Program up to $1000 per year Referral Program Employee Assistance Program An environment of like-minded people reaching for the same goal Serving the underserved community A sense of purpose
Who We Are
Since 1951, Kings View leads the community in providing behavioral health services to the underserved population. We have a strong tradition of commitment, and we focus on serving rural communities where health resources are often limited. Our people treat the community with care and compassion. We stand by our cornerstone and philosophy of valuing each persons worth, dignity and wholeness in body, mind, and spirit. Our principal core values echo throughout the organization and into our patient-focused programs. At Kings View we are dedicated to continuing our demonstration in the unparalleled commitment to wellness and recovery within each community we serve. Join us and apply today.
