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Provider Enrollment and C&P Specialist

Company: La Clinica de la Raza
Location: Oakland
Posted on: June 6, 2021

Job Description:

Are you eager to join a culture that is able and committed to making a difference in people's lives? La Clnica's vision is to be the premier community health center, rooted in the concepts of wellness, prevention, and patient-centered care. In order to achieve our vision, we strive to attract and inspire an engaged workforce that can provide the best patient care experience. We serve the entire community and are committed to providing culturally and linguistically appropriate care.

About the Position: Under the direction of the Provider Enrollment and Contracts Supervisor, maintain clinical provider credentialing files, coordinate credentialing and re-credentialing application process of clinical providers (medical, dental, optometry, and behavioral health) and clinics with participating health insurance plans.

Duties and Responsibilities:

Health Plan Contracts:

* Develop and maintain provider credentialing files and internal electronic tracking systems. * Review clinical provider applications for completion and accuracy, ensure timely and accurate follow-up; monitor and report on the credentialing progress of each practitioner. * Maintain timely and accurate data entry, and periodically revise provider data in the department records; maintain provider demographic and electronic data files; use Council for Affordable Quality Healthcare (CAQH) system to submit provider data as required by health plans. * Utilize extensive Internet and telephone communication to obtain and share information. * Notify insurances carrier and other relevant entities of provider changes. * Update health plan directories with accurate information about participating clinics and providers. * Act as liaison between providers and contracted insurance plans in the areas of credentialing, provider relations, and orientations. * General administrative tasks as needed.

Credentialing & Privileging:

* Assist with all duties related to credentialing and privileging (C&P) aligned with La Clinica C&P policy * Utilize ECHO to maintain a current and accurate record of C&P provider data, including initial and re-credentialing * Maintain and monitor credentialing files with all required supporting documentation * Coordinate the credentialing process, as outlined in the agencys policy, for all new providers, including employees, volunteers, locums, and independent contractors. * Collaborate with the HR recruiters to monitor the recruitment status of candidates to ensure timely credentialing prior to employment * Communicate with clinic managers to ensure the re-credentialing requirements are met and maintained * Maintain and closely monitor clinical license, certification, and/or required regulatory registration (DEA, BLS, etc.) for all providers to ensure C&P requirements are current at all times. * Manage the electronic tracking systems to capture and report on all credentialing requirements

Job Requirements:

* Demonstrated ability and commitment to excellent customer service to maintain and ensure effective working relationships with internal and external clients * Excellent attention to detail and a high degree of accuracy, in a fast-paced environment * High level of organizational skills and demonstrated ability to maintain and improve systems * Ability to maintain confidentiality * Demonstrated ability to perform tasks involving independent judgment * Ability to manage multiple projects efficiently and accurately, prioritizing and managing deadlines * Proficient in Microsoft Office (Word, Outlook, Excel) and office machines * Able to maintain a steady pace, at times working at a fast pace to meet deadlines or when working under short notice * Six months of administrative experience

Job Preferences:

* High School diploma * 1-2 Years work experience in all facets of credentialing, including interacting with physicians and other health care providers. * Experience in working with various databases * Experience with medical and professional credentialing processes, policies, and procedures, including credentialing requirements * Experience with practitioner credentialing, data collection, and record management systems * Experience in a community health care setting, preferably with insurance or managed care plans experience

Keywords: La Clinica de la Raza, Oakland , Provider Enrollment and C&P Specialist, Other , Oakland, California

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