Credentialing Specialist - NEEDED ASAP IN PASADENA
Location: Pasadena
Posted on: January 15, 2021
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Job Description:
Credentialing Specialist needed for a special project for a
major health care provider in Pasadena.
Will provide administrative and technical management for
credentialing and/ or appointment and re credentialing and/ or
reappointment functions. Represents all affiliated community
practitioners during monthly Credentialing/Peer Review Committee
meetings. Collaborates with all necessary entities to achieve
credentialing and/ or privileging function. Handles complex,
non-routine files/requests requiring use of independent judgment
and provides guidance to practitioners regarding relevant
laws/regulations and interpretation. Works in team-based department
with Credentialing and Privileging Services personnel to complete
all compliance and time requirements necessary to maintain
organization's accreditation.
Essential Functions:
? Provides administrative and technical expertise to credentialing
services functions. Completes credentialing and re credentialing
application process of all internal and affiliated community
practitioners. Processes request, investigation, verification,
tracking and follow up of primary responses from various
sources.
? Identifies, investigates, reports, tracks, and follows-up on any
potentially adverse information received from credentialing and
privileging sources.
? Reviews files for any "red flag" issues. Routes accordingly.
? Obtains and maintains appropriate knowledge of company policy and
procedures, accreditation standards, state and federal regulations,
guidelines, procedures and laws required in credentialing
process.
? Ensures alignment of competencies with national and community
standards of practice, regulatory, and accreditation standards
(e.g. TJC, NCQA, AAAHC, DOH)Populates, updates, and maintains
credentialing software and filing systems. Assists and creates with
Requests for Proposals or any requested reports as necessary and in
collaboration with Supervisor or other Credentialing/ Privileging
personnel.
? Maintains practitioner files monthly.
? Ensures medical licenses, DEA certificates and malpractice
certificates are current at all times for affiliated community
practitioners.
For immediate consideration, please send your resume as a Word doc
and place a follow up call to Vivian Latifian. We are an equal
employment opportunity employer and will consider all qualified
candidates without regard to disability or protected veteran
status.
Keywords: , Pasadena , Credentialing Specialist - NEEDED ASAP IN PASADENA, Healthcare , Pasadena, California
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