Credentialing Specialist - NEEDED ASAP IN PASADENA

Location: Pasadena
Posted on: November 14, 2024

Job Description:

Credentialing Specialist needed for a special project for a major health care provider in Pasadena.

Will provide administrative and technical management for credentialing and/ or appointment and re credentialing and/ or reappointment functions. Represents all affiliated community practitioners during monthly Credentialing/Peer Review Committee meetings. Collaborates with all necessary entities to achieve credentialing and/ or privileging function. Handles complex, non-routine files/requests requiring use of independent judgment and provides guidance to practitioners regarding relevant laws/regulations and interpretation. Works in team-based department with Credentialing and Privileging Services personnel to complete all compliance and time requirements necessary to maintain organization's accreditation.

Essential Functions:

? Provides administrative and technical expertise to credentialing services functions. Completes credentialing and re credentialing application process of all internal and affiliated community practitioners. Processes request, investigation, verification, tracking and follow up of primary responses from various sources.

? Identifies, investigates, reports, tracks, and follows-up on any potentially adverse information received from credentialing and privileging sources.

? Reviews files for any "red flag" issues. Routes accordingly.

? Obtains and maintains appropriate knowledge of company policy and procedures, accreditation standards, state and federal regulations, guidelines, procedures and laws required in credentialing process.

? Ensures alignment of competencies with national and community standards of practice, regulatory, and accreditation standards (e.g. TJC, NCQA, AAAHC, DOH)Populates, updates, and maintains credentialing software and filing systems. Assists and creates with Requests for Proposals or any requested reports as necessary and in collaboration with Supervisor or other Credentialing/ Privileging personnel.

? Maintains practitioner files monthly.

? Ensures medical licenses, DEA certificates and malpractice certificates are current at all times for affiliated community practitioners.

For immediate consideration, please send your resume as a Word doc and place a follow up call to Vivian Latifian. We are an equal employment opportunity employer and will consider all qualified candidates without regard to disability or protected veteran status.

Keywords: , Rancho Santa Margarita , Credentialing Specialist - NEEDED ASAP IN PASADENA, Healthcare , Pasadena, California