Dermatology Credentialing Specialist

Skin and Cancer Institute • Cerritos, CA, United States • $200k - $250k / year • 3w ago

Responsible for all aspects of the credentialing, recredentialing and privileging processes for all medical providers who provide patient care. Responsible for ensuring providers are credentialed, appointed, and privileged with health plans, hospitals and patient care facilities. Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.

MUST BE PROFICIENT IN CREDENTIALING SOFTWARE, preferably Modio

ESSENTIAL DUTIES

Compiles and maintains current and accurate data for all providers.
Completes provider credentialing and recredentialing applications; monitors applications and follows-up as needed.
Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
Maintains corporate provider contract files.
Maintains knowledge of current health plan and agency requirements for credentialing providers.
Sets up and maintains provider information in online credentialing databases and system.
Tracks license and certification expirations for all providers to ensure timely renewals.
Ensures practice addresses are current with health plans, agencies and other entities.
Processes applications for appointment and reappointment of privileges.
Tracks license, DEA and professional liability expirations for appointed ASC providers.
Maintains ASC appointment files, and information in credentialing database.
Audits health plan directories for current and accurate provider information.

ADDITIONAL RESPONSIBILITIES:

Maintains confidentiality of provider information.
Provides credentialing and privileging verifications.
Performs other duties as assigned.

Skills:

Knowledge and understanding of the credentialing process.
Ability to organize and prioritize work and manage multiple priorities.
Excellent verbal and written communication skills including, letters, memos and emails.
Excellent attention to detail.
Ability to research and analyze data.
Ability to work independently with minimal supervision.
Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.
Proficient use of Microsoft Office applications (Word, Excel, Access) and internet resources.

EQUIPMENT & SOFTWARE OPERATION

The incumbent in this position may operate any/all of the following equipment: Microsoft Outlook, Word, Excel, PowerPoint, fax, email, phone, NextGen, EMA.

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