LifeLong Medical Care

  • Credentialing Assistant/Provider Enrollment

    Job Locations US-CA-Berkeley
    Posted Date 1 month ago(11/5/2018 4:18 PM)
    ID
    2018-1898
  • Overview

    Supporting Community Healthcare is a rewarding role.  LifeLong Medical Care is looking for a Credentialing Assistant to manage our credentialing processes. This position works from our Administrative Offices in Berkeley and is a benefited position set to work 40 hours per week.

     

    LifeLong Medical Care is a Federally Qualified Health Center in Northern California with over 42 years of dedicated service to the community. LifeLong provides comprehensive, compassionate care to over 60,000 patients in socio-economically underserved regions of the East Bay Area. We provide medical, dental, behavioral health, and school-based services at 20 sites across Oakland, Berkeley and West Contra Costa County. 

    Our mission is to provide high-quality health and social services to underserved people of all ages; create models of care for the elderly, people with disabilities and families; and advocate for continuous improvements in the health of our communities. LifeLong Medical Care is an Equal Opportunity Employer. 

     Benefits:

    • Paid time off, sick and vacation
    • Medical and dental benefits
    • 403B retirement plan

     

     LifeLong Medical Care is an Equal opportunity employer. People of color, women and LGBT are encouraged to apply.

    Responsibilities

    Essential Functions  

     

    • Assists the Provider Enrollment/Credentialing Coordinator to ensure clinicians and support staff are properly credentialed and privileged.
    • Completes enrollment applications, revalidations and rejections for Provider Enrollment, Chain, and Ownership System (PECOS) and Centers for Medicare & Medicaid Services (CMS).
    • Utilizes ADP to maintain a current and accurate record of provider data for use in the credentialing, re-credentialing, and appointment process.
    • Processes provider credentialing applications, re-applications, new hires, and terminations, including: primary source verification, secondary source verification, data entry into roster database, and health plan network enrollment and renewals.
    • Monitors all applicable expiration dates for clinicians; tracks and sends out notification letters/emails/phone calls, as needed to ensure all licenses including license, Drug Enforcement Division (DEA) and cardiopulmonary resuscitation (CPR) are current and the proper documentation is on file.
    • Processes approval, denial, or termination letters.
    • Maintains the credentialing files and required documentation of all credentialed clinicians. Conducts credentialing file audits as needed to ensure files are “audit ready” and in compliance with established policies and procedures.
    • Provides required documentation to appropriate clinician’s managers and committees at the practice sites.
    • Collaborates with clinician recruiter to monitor recruitment status of candidates to ensure timely credentialing prior to employment.
    • Produces relevant reports and documents as required for Billing, Finance, Quality Improvement, and other outside agencies.
    • May interact with health plans and other payor organizations to ensure accurate provider data are communicated to and maintained by payors.
    • Maintains effective working relationships with Clinical, Billing, IT, Quality Improvement, administrative support staff, and other credentialing agencies and health plans to ensure necessary flow of information to maintain credentialing.
    • Maintains current knowledge of Accreditation Association for Ambulatory Health Care (AAAHC), Health Resources and Services Administration (HRSA), Federal Tort Claim Act (FTCA) and all relevant laws and regulations regarding Federally Qualified Health Center (FQHC) credentialing requirements.
    • Maintains files of current Scopes of Practice for all specialties to meet current Federal and State Program and Regional requirements.
    • Assists with reviewing, updating, developing credentialing policies, procedures and processes in coordination with the Chief Medical Officer and Director of Human Resources.  
    • Other duties as assigned by supervisor.

    Qualifications

    Job Requirements

    • Bachelor’s Degree or equivalent combination of education and/or experience.   
    • Minimum of two years of experience with medical credentialing and knowledge of Federal and State regulatory requirements  and accreditation standards e.g., The Joint Commission, TITLE 22, NCQA, NPDB, and certifying agencies.
    • Proficient with Medical Terminology.
    • Administrative experience with proficiency in  Microsoft Office, Outlook, Word, and Excel.

     

    Job Preferences        

    • Bachelor’s degree.
    • Community Health experience.
    • Med Staff or Medical Information Data Analysis System experience.
    • Certification as Certified Provider Credentialing Specialist (CPCS).

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