Credentialing Specialist, Clever Care Health Plan, Orange County, CA

Posted on June 20th, 2019

About Clever Care Health Plan:

• Clever Care Health Plan is a new Medicare Advantage insurance company (started in 2019; www.clevercarehealthplan.com). We plan to serve Medicare beneficiaries in Southern California. Our office is located at Little Saigon in Orange County (8990 Westminster Blvd, Westminster, CA 92683).  We are passionate in providing best services to our healthcare providers. Our goal is to be the best partner for our providers by creating an easy, reliable and fast credentialing services.

Position Summary:

• The Credentialing Specialist is responsible for ensuring that healthcare providers meet federal and state requirements. He/she is responsible for all aspects of the credentialing and re-credentialing processes of professional and institutional health providers. Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications. Competitive compensation with health insurance benefit.

Job Functions and Responsibilities:

• This position is responsible to:
  • Ensure heath care providers in the health plan’s network are in good standing. All providers meet federal and state requirements to serve Medicare beneficiaries.
  • Review credentialing files and work with healthcare providers to obtain missing, incomplete and expiring items.
  • Compiles and maintains current and accurate data for all providers.
  • Completes provider credentialing and re-credentialing applications; complete primary-source verification; monitors applications and follows-up as needed.
  • Completes location credentialing and re-credentialing 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.
  • Maintains information in credentialing database.
  • Audits health plan directories for current and accurate provider information.
  • Participates and health plan audits
  • Establish and maintain long-term working relationships with healthcare providers to ensure customer satisfaction and retention.
  • Maintain an accurate and reliable provider database for our members.
  • Maintain consistent contact with healthcare providers to ensure that expectations are clear and requirements are completed in a timely manner.
  • Utilize advanced problem-solving skills to resolve issues and conflicts that may arise.
  • Performs other duties as assigned.

Qualifications:

• Associate degree or Highschool diploma.
• 2 years of experience in provider credentialing. Practical-knowledge to use NPDB or Credentialing software.
• Ability to speak in Vietnamese or Chinese Mandarin fluently.
• Well-organized and detail orientated. Professional demeanor. Strong customer service.
• Certified Provider Credentialing Specialist (CPCS) is preferred.

Please email your resume directly to Human.Resources@CleverCareHealthPlan.com