Credentialing Specialist

Position Summary:

The Credentialing Specialist supports credentialing and re-credentialing processes for applicants of the SYH Medical Staff. Program/health plan applications and reappointment applications are also processed in accordance with established policies, rules and regulations, bylaws, and regulatory governmental standards, ensuring only qualified practitioners work with San Ysidro Health and participate in all programs.

Essential Functions of the Job:

• Work closely with provider enrollment specialist and Credentialing Manager to complete provider enrollment to County/State/Federal programs.

• Perform credentialing and re-credentialing activities of all providers and practitioners including physicians, mid-level practitioners; involves detailed review of documents and data.

• Complete and process credentialing applications.
• Oversee the collection of all pertinent primary source verification for all providers and practitioners.
  • Enter data into Verity and maintain database.
  • Assists with credentialing inquiries both internal and external.
  • Maintains knowledge of current health plan and agency requirements for credentialing providers.
  • Travels to different SYHealth locations to obtain required signatures and paperwork when re-credentialing is required.
  • Setting appointments with new providers to come to corporate offices and walking them through applications.
  • Be able to multi-task and work in a fast-paced environment, have strong attention to detail, and the ability to work autonomously
  
  
  Additional Duties and Responsibilities:
  
  
  • Performs any other job-related duties as needed, assigned, or requested.
  • Must be highly motivated individual with excellent organizational skills to manage large volumes of information and multiple assignments; attention to detail is key.
  • Possess strong customer focus and expertise in setting and managing customer expectations.
  
  
  Job Requirements:
  
  Education Required (Minimum level of education):
  
  High School Diploma or GED equivalent
  
  Certifications/Licenses Preferred:
  
  N/A
  
  Experience Required (Minimum level of experience):
  
  Minimum of 2 years credentialing or administrative healthcare related experience.
  
  Verbal and Written Skills Required to perform the Job:
  
  Written Communications: Ability to communicate clearly & effectively in written English with internal & external customers.
  
  Oral Communications: Ability to comprehend & converse in English to communicate effectively with medical center staff, patients, families & external customers.
  
  Technical Knowledge and Skills Required to Perform the Job:
  
  Basic computer skills required. Health Plan portals, MS Office (Excel, Power point, Word). Must type approximately 35 wpm.
  
  Ability to proficiently maneuver through all electronic applications used for job.
  
  Ability to work collaboratively in small teams to improve the operations of immediate work group by offering ideas, identifying issues & respecting team members.
  
  Equipment Used: Computers, Software systems, Scanner, Telephones, Copy and Fax machines.
  
  Working Conditions and Physical Requirements:
  
  Prolonged, extensive, and considerable standing/Sitting/Walking/Lifting.
  
  Universal Requirements
  
  Pre employment requirements include I-9, physical, positive background and reference check results, complete application, new hire orientation, pre-employment PPDs. Compliance with all mandated vaccinations and all boosters is a term and condition of employment.

About Us San Ysidro Health is a Federally Qualified Health Care organization committed to providing high quality, compassionate, accessible and affordable healthcare services for the entire family. The organization was founded by seven women in search of medical services for their families and community. Almost 50 years later, San Ysidro Health now provides innovative care to over 108,000 patients through a vast and integrated network of 47 program sites across the county. San Ysidro Health could not serve our patients without the dedication of our passionate and hardworking employees. Apply today and become a part of our mission-driven team! San Ysidro Health has a long-standing commitment to equal employment opportunity for all applicants for employment. Employment decisions including, but not limited to, those such as employee selection, performance evaluation, administration of benefits, working conditions, employee programs, transfers, position changes, training, disciplinary action, compensation, and separations are made without regard to race, color, religion (including religious dress and grooming), creed, national origin, nationality, citizenship status, domestic partnership status, ancestry, gender, affectional or sexual orientation, gender identity or expression, marital status, civil union status, family status, age, mental or physical disability (including AIDS or HIV-related status), atypical heredity cellular or blood trait of an individual, genetic information or refusal to submit to a genetic test or make available the results of a genetic test, military status, veteran status, or any other characteristic protected by applicable federal, state, or local laws.

Other details

• Pay Type Hourly
• Min Hiring Rate $18.27
• Max Hiring Rate $27.40

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