Provider Services Credentialing Specialist

We have an opportunity to join the Alliance as a Provider Services Credentialing Specialist (overseeing/leading/in) the (name) Department.
WHAT YOU'LL BE RESPONSIBLE FOR

• Conducting provider credentialing and re-credentialing, including performing Primary Source Verifications
• Researching and analyzing complex credentialing issues and developing and proposing solutions
• Performing and monitoring of physician license status and state and federal sanctions of contracted and non-contracted providers and conducting related investigations

Performs other duties as assigned
ABOUT THE TEAM
Provider Services works with our providers as a partner in giving high-quality, safe and compassionate care to our members.
WHAT YOU'LL NEED TO BE SUCCESSFUL
To read the full position description, and list of requirements click here

• Knowledge of:
  
  • Healthcare terminology
  • Methods and techniques of research, analysis and reporting
  • Methods and techniques of data entry and data auditing
  • Principles and practices of customer service
  • Some knowledge of managed care concepts
  • Some knowledge of the basic principles and practices of project management
• Ability to:
  • Interpret, explain and apply policies, procedures, laws, regulations and contract language
  • Identify and troubleshoot issues, gather and analyze information and data, identify alternative solutions and make recommendations for action
  • Enter, proofread, verify, analyze and audit data, and identify data anomalies
  • Organize work, manage multiple tasks, establish priorities, adjust to changing priorities, and meet deadlines
  • Assist with the development and maintenance of workflows, work instructions, policies and procedures
  • Quickly become familiar with providers and credentialing activities in assigned counties.
• Education and Experience:
  • Bachelor's degree in Business or Public Administration, Public Policy, Health Care or a related field and a minimum of three years of experience performing credentialing, compliance or other regulatory functions in a healthcare or government setting (a Master's degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying

OTHER DETAILS

• While this position is connected to one of our Alliance offices, we are in hybrid remote/in-office work environment right now and we anticipate that the interview process will take place remotely.
• Our Alliance office locations have officially re-opened as of May 2, 2022 and while some employees may work in full-time telecommute schedules, attendance at quarterly company-wide events or department meetings will be expected.
• Based on the nature of work, this position may require onsite presence, which is dependent on business need. Details about this can be reviewed during the interview process.

The full compensation range for this position is listed by location below.
The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).
Santa Cruz County Pay Range
$59,176 - $94,682 USD
Merced County Pay Range
$53,850 - $86,174 USD
OUR BENEFITS

• Medical, Dental and Vision Plans
• Ample Paid Time Off
• 12 Paid Holidays per year
• 401(a) Retirement Plan
• 457 Deferred Compensation Plan
• Robust Health and Wellness Program
• Onsite EV Charging Stations

ABOUT US
We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.
Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet .
The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer
At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.