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Form of work
SalaryABOUT PRECISION DIAGNOSTICS:
Precision Diagnostics (“Precision” or the “Company”), based in San Diego, California is a fast-growing laboratory that specializes in providing quantitative drug testing, primarily for helping physicians monitor their patient’s undergoing treatment for pain or substance abuse. Precision’s objective is to improve patient adherence/compliance with their prescription regimen and protect medical practices from liability.
OUTCOMES:
We are seeking to hire a Contract & Credentialing Specialist to be part of our Contracting & Credentialing Department and will be accountable for performing the primary source verification process for all initial credentialing and revalidation/re-credentialing applications. The Specialist will be responsible for sending, receiving, and processing all credential applications for the laboratory on a regional and national level. This position will be responsible for performing primary source verification of education, training, experience, licensure, claims history, according to state and federal accrediting standards. This position reports to the Director of Managed Care.
DUTIES:
Initiate payer outreach and begin application/contracting process as needed.
Draft Letters of Interest (LOI) and proposals to contract as requested.
Follow up on LOI’s in a consistent manner.
Professionally request reconsiderations of unaccepted or denied proposals as appropriate.
Set up EFT enrollment for new payers as needed.
Answer and respond to complex questions and inquiries via telephone and electronic messaging systems utilizing established procedures.
Work under minimal supervision and assist less experienced peers.
Responsible for performing a thorough review ensuring all documents have been received in initial credentialing or re-credentialing application.
Assemble electronic files and prepare credential files for submission & processing for next level evaluation.
Follow up with various departments to acquire any missing information while for completion.
Review of the application prior to expiration of credentialing or network membership to ensure credentials remain current.
Create the appropriate cycle credentialing effort in the corresponding system to initiate the credentialing verification process.
Track, verify, and document expirable & current credentials using acceptable verification sources to ensure compliance with accreditation and regulatory standards.
Tracks and obtains documents and applications from providers prior to re-credentialing expiration in compliance with our payer contracts, policies and procedures, and state or federal regulations.
Manage and maintain current copies of all medical license records for management/ laboratory directors, ownership, and all required credentialing documents for the laboratory.
Maintain corporate provider contract & agreement files.
Maintain credentialing database and continuous, consistent data integrity to ensure that accurate and current information is available to all systems and departments.
Communicates with director and associates regarding credentialing status,
information, and maintain current documents as required.Collaborates with credentialing management on the streamlining and updating of credentialing processes.
Initiates and follows through on all aspects of the credentialing process, including initial and follow up credentialing, for all the insurances company is contracted with.
Performs other related duties as assigned.
WHAT YOU BRING TO THE TABLE:
Healthcare Industry experience with focus on provider credentialing & enrollment preferred. Comparable application and data processing experience will be considered.
Bachelor’s degree in relevant area preferred.
3 years of relevant credentialing experience.
NAMSS Certified Provider Credentialing Specialist (CPCS) preferred.
Experience in complying with accreditation and regulatory standards in addition to compliance with state and federal accreditation standards and regulatory requirements.
Communication and interpersonal skills to interact with faculty and staff at all levels in a fast-paced environment under consistent pressure with the ability to work well with others and accept direction.
General knowledge of the U S Healthcare system and workers compensation industry.
Excellent verbal and written communication skills as well as listening skills and reading and writing comprehension to technical and non-technical audiences of various levels within the organization (e.g., executive, management, individual contributors).
Excellent problem solving, time management, and work prioritization skills.
Exercise independent thinking and judgment.
Requires proficient negotiation skills and tactics, both written and verbal.
Self-starter with experience handling high work volume and multiple projects.
Ability to establish and maintain positive relationships with internal and external customers and be a team player.
Ability to work effectively in a high-pressure environment.
Ability to adapt behavior in response to new information or changing circumstances.
Must be able to successfully maintain multiple projects simultaneously, manage and meet multiple deadlines, be detail-oriented, and possess strong organizational skills.
Maintains confidentiality regarding legal matters, privacy issues, information technology, and data integrity.
Detail Oriented
Clerical office, data entry, e-filing, and customer interfacing/communication experience required (preferably in a healthcare setting).
To be successful, you agree that technology is a key part of every business process, and you will make new technology adoption part of your routine
Become fluent in Microsoft 365 (formerly Office635) applications assigned to your role. Common applications include Teams, Word, Excel, Tasks and Planner
Complete training in a timely manner that is assigned to you. Training is primarily conducted via Microsoft Learn modules and is assigned based on:
Position/Job Role – Most positions require a core set of Microsoft 365 working knowledge
Project Role – As member of a project team, you may be required to complete training before you can engage with the project team or commence project work
Ad-Hoc – Based on review of your performance via support requests, training modules will be assigned to increase skills
ADDITIONAL JOB CONSIDERATIONS:
This position is Full Time and fully remote.
Hourly pay range of $28-$32
Standard hours M-F 8am to 4:30pm PST, 40 hours per week.
This job is primarily sedentary and may involve repetitive motions; the employee is regularly required to sit, use hands and fingers, speak, and hear.
The employee is occasionally required to stand, walk, and lift objects (up to 10 lbs. weight; up to 4 ft. height).
Specific vision abilities required by this job include the ability to see things from a close distance and the ability to adjust focus.
Comprehensive benefits package: Medical, Dental, Vision, and additional optional coverages.
401K with company match
Paid time off and paid Holidays.
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.
