Careers
Credentialing Specialist
Location: Chatsworth, CAStatus: Full-time
Salary: Commensurate with experience
Job Description:
General Summary
The Credentialing Specialist will serve as a focal point of GRMM’s credentialing process, distribute and receive files for review, analyze applications and perform primary source verification, prepare files for review, monitor and document credentialing efforts, serve as a knowledge expert on credentialing, monitor credentialing status of contracted provider to ensure timely re-credentialing, continuously improve the credentialing process, and perform general administrative support tasks as needed.
Principal Duties & Responsibilities
The Credentialing Specialist will ensure the timely and thorough credentialing and re-credentialing of GRMM providers and other covered staff. Duties include managing and maintaining the data bases related to credentialing; managing and maintaining the credentialing profiles for the personnel files; gathering and assembling all requisite documents; ensuring that all documents are complete and thorough; transcribing requisite information from source documents onto insurance, background and or related forms; obtaining signatures; assembling, copying and mailing documents as per procedure; processing to completion credentialing with insurance companies; timely notifying staff regarding licensure expiration; liaison with insurance companies; medical directors and affiliates.
Major challenges of this position include managing a high volume of work with critical deadlines, analyzing complicated applications for thorough and current information, and staying abreast of frequently changing internal policies and procedures and external standards and requirements.
Requirements
• High School Diploma or GED
• Two years credentialing experience, including processing initial/reappointment applications and conducting credential’s verification and follow-up is highly preferred
• Experience in a managed care setting and with Medicaid (Medi-Cal) also preferred
• CMSC/CPCS certification is a plus
• Proficiency with PC-based software, knowledge of and experience with implementing accreditation standards (i.e. NCQA), and excellent oral and written communication skills are necessary
• Experience with credentialing software is preferred
• Effective initiative, resourcefulness, and problem solving skills are a must
• Proficiency in organizing and prioritizing work, establishing procedures and systems, and ensuring orderly and timely flow of business through the office is essential
• Attention to detail is necessary
• On occasion, must be able to attend meetings outside of regular work hours
