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Form of workThe purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups hospitals health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options including medical dental and vision plans for the employee and their dependents Health Spending Account (HSA) Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.
Assist with all credentialing activities associated with all IPAs and product lines managed by DHMSO. Works with Credentialing Supervisor Medical Directors Provider Relations Department Contracting Department health plans providers provider office staff and other persons or businesses as necessary to ensure that all providers are properly credentialed according to NCQA and health plan standards. Where appropriate makes recommendations regarding improvement of processes and procedures.
Responsibilities may include:
- Keep current on all NCQA and health plan credentialing standards, policies, and procedures.
- Maintain access to all Primary Source Verification websites.
- Assists with performing internal primary source verifications and full credentialing for those providers who are to be credentialed on a RUSH basis. RUSH status is to be determined by administration including CEO and Medical Directors.
- Keep all credentialing files and credentialing database current and complete.
- Attend assigned meetings pertaining to provider credentialing and provider network management as assigned, including but not limited to Provider Information Meetings sponsored by Provider Relations Department on a quarterly basis, QM & Credentialing Committee meeting for GEMCare Medical Group, and MasterCare IPA Board of Directors.
- Coordinate credentialing activities with Supervisor as needed, and keep supervisor informed of status of credentialing activities on a regular basis.
- Validate information in master credentialing database against information in health plan database.
- Perform other duties as assigned.
Minimum Qualifications:
- One to two (1-2) years of experience in the healthcare industry required, preferably with experience in credentialing.
- Excellent analytical and organizational skills required. Highly detail oriented, creative and proven problem solver. Strong attention to detail and ability to analyze same.
- Self-directed and able to work independently under tight time frames. Able to interact with co-workers, managers, supervisors, and administrators in a manner that promotes a positive work environment.
- Strong MS Office Suite skills (Word, Excel, PowerPoint and SharePoint) and proven ability to learn/use company specialized software and hardware.
Preferred Qualifications:
- One or more (1+) years of vocational or college coursework preferred. Bachelor's degree preferred.
- Prefer Certified Provider Credentialing Specialist certification (CPCS).
***This position can be onsite or remote within California.
