Credentialing Specialist

One Community Health Sacramento , CA 95811

Posted 1 week ago

Looking for a Credentialing Specialist in our Thriving Organization!

One Community Health is expanding! With the opening of our new building in Midtown and our new clinic in the Arden Arcade area, we are looking for talented, enthusiastic and committed individuals to join our team!

Our Philosophy

At One Community Health we believe healthcare isn't a privilege; it's a human right. Everyone should have the opportunity to achieve optimal health. We've made it our job to help individuals and our community lower the barrier to wellness. Our organization pushes for equality for all and for social justice for those on the margins. Our doctors and health care professionals treat people with compassion, without judgment for their personal choices and behavior. We provide a comprehensive menu of services to everyone in need, and we advocate for public awareness of such issues as the stigma surrounding mental illness and the need for healthcare for everyone. We understand the impact of trauma on one's health and are working to help people heal those wounds. When we see suffering, we try to heal it whether it be an individual in pain or a group in our community. If these are your values are your values, then please consider joining our team.

What We Are

We are a Federally Qualified Health Center (FQHC) serving all those in need in the Sacramento area. We have been a level 3 Patient Centered Medical Home since 2011 and were the first to earn that designation in Sacramento. Integrated, comprehensive and supportive services to maximize health outcomes. The founding values of One Community Health were based on providing a safe and welcoming place for people who often experienced social exclusion and discrimination.

Our Benefits

  • Medical Insurance

  • We offer a choice between two carriers: Blue Shield and Kaiser Permanente.

  • One Community Health pays about 90% of the Employee only premium and pays 75% of the costs for dependents or partners/spouses.

  • Dental/Vision

  • 2 Dental plans offered through Delta Dental: PPO and DHMO

  • DHMO is paid in full by employer (employee only)

  • VSP Vision Insurance paid in full by employer (employee only)

  • Company Paid Life, AD&D and LTD offered through Unum

  • One times annual salary paid in full by employer (LIFE and AD&D)

  • LTD is 60% annual salary paid in full by employer after 90 days

  • Flexible Spending Plan (before-tax savings plans)

  • Employee Assistance

  • Supplemental Insurance through Aflac

  • 401K

  • Up to 4% employer match at 90 days of employment

  • Administrative fees and administration of plan managed and paid for by employer

  • Robust PTO, Floating Holiday, Emergency Sick Time, & Paid Holidays

  • Additional Benefits/Extra's

  • We are an eligible NHSC (National Health Service Core) approved loan repayment site and are proud to have a HPSA score of 16.

  • Educational and Language Stipends: higher level of education or secondary languages

  • Professional dues and/or licensure fees paid by organization as it relates to the job

  • Professional training and/or conference/travel fees paid by organization

  • Opportunity for annual merit increase and pay for performance if annual performance goals met

About the Position

Specializes in and performs the entire credentialing process for all providers as required by established requirements. Works with providers, administration, and vendors as necessary to ensure accurate and timely provider credentialing, enrollment, licensure and exclusion verifications

Essential Functions:

Obtain, Process and Maintain Provider Credentialing Information

  • Work with providers, administration and Credentialing Verification Organization to ensure timely credentialing of all providers.

  • Enter and maintain all Provider information into designated databases.

  • Enter and maintain Provider applications, updates, and other documentation into the system.

  • Maintain credentialing information by reviewing, entering and following up on missing information.

  • Maintain a list and follow up on providers that need re-credentialing and coordinate re-credentialing process.

  • Maintain a list and follows up on providers that need re-privileging and assists in coordinating and tracking the re-privileging process.

  • Run provider queries into National Practitioners Data Bank for adverse charges pending or filed against provider.

  • Enter data into other designated databases and systems, including but not limited to CAQH, and PECOS.

  • ePCS provider enrollment and administration.

  • Assist with maintaining Privileging information.

  • Assist with clinic licensure and registrations as necessary.

Multi-Disciplinary Communication and Collaboration

  • Attends regular meetings such as Peer Review Committee.

  • Sends out regular communication to multi-disciplinary teams related to the status of providers credentialing.

  • Works with the leadership team on any credentialing concerns that arise.

Compliance of Policy, Procedures and Other Requirements

  • Works within the organizational guidelines to maintain a credible and compliant credentialing process.

  • Works within the guidelines set forth by other governing bodies such as HRSA, CMS and other local, state and federal entities in which we do business with.

Tracking, Reporting and Monitoring of Licenses and Certifications

  • Verify potential and existing Provider's license, DEA and other licenses, registrations or certificates, as necessary.

Insurance Enrollment Functions

  • Perform ongoing research as to providers that need to be enrolled with or removed from health plans as needed.

  • Work with Patient Financial Services Director on providers needing enrollment and contracts with health plans as needed.

  • Complete and submit provider enrollment applications and required paperwork.

  • Keep up to date provider enrollment process and records and track provider participation levels. Track enrollment applications status as needed.

  • Update lists and systems to reflect provider enrollment approvals, denials and/ or terminations as needed.

Education/ Experience Required:

  • Bachelor's Degree (preferred)
  • 2 years relevant Health Care Experience (preferred)
  • CPCS Certification (preferred)
  • All relevant Licenses/certifications must be kept current and in good standing.

Please Note:

One Community Health values the diversity of the people it hires and serves. Diversity at One Community Health means fostering a workplace in which individual differences are recognized, appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths. We are an Equal Opportunity Employer. We do not discriminate on the basis of race, religion, color, sex, age, national origin, gender identity, sexual orientation or disability. Please provide us with notice if you will require accommodations during the interview process

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