Provider Services Credentialing Specialist, Central California Alliance for Health, Scotts Valley, CA
Posted on July 29th, 2019
We have an opportunity to join the Alliance as a Provider Services Credentialing Specialist in the Provider Services Department.
WHAT YOU'LL BE RESPONSIBLE FOR
Reporting to the Provider Services Credentialing Supervisor, you will coordinate the provider credentialing function for your assigned county and perform application intake and ensure that the credentialing database accurately reflects provider credential files and primary source data. You will also perform ongoing monitoring of license status and state and federal sanctions of contracted and non-contracted providers, collaborate with other Credentialing staff to support Peer Review Credentialing Committee (PRCC) meetings, and ensure successful data integrations with other organizational databases for proper claims payment and provider data reporting.
THE IDEAL CANDIDATE WILL HAVE
- Experience performing provider credentialing functions, working with credentialing software (eVips preferred), and performing data entry and data analysis
- Experience working in a County Organized Health System
- Bachelor's degree in Social Science, Business Administration, Healthcare of related field
WHAT YOU'LL NEED TO BE SUCCESSFUL
To read the full position description, and list of requirements click here (http://www.ccah-alliance.org/positions/Provider_Services_Credentialing_Specialist.pdf)
- Methods and techniques of data entry and data auditing
- Methods and techniques of research, analysis and reporting
- Healthcare terminology
- Managed care concepts
- Understand and interpret policies, procedures, regulations and contract language
- Identify and troubleshoot potential and actual problems, identify alternative solutions and make recommendations for action
- Proofread, verify, analyze and audit data
- Quickly become familiar with providers and credentialing activities in assigned county
Education and Experience:
- Associate’s degree and a minimum of four years (or high school diploma or equivalent and a minimum of five years) of experience in a healthcare environment performing credentialing, compliance or office management functions; or an equivalent combination of education and experience may be qualifying
- Medical, Dental and Vision Plans
- Ample Paid Time Off
- 11 Paid Holidays per year
- 401(a) Retirement Plan
- 457 Deferred Compensation Plan
- Robust Health and Wellness Program
- EV Charging Stations
- And many more! (http://benefits.filice.com/centralcalifornia/2019/benguide.pdf)
For a complete position description and to apply online, please visit our careers website at https://grnh.se/5edcf22d1
We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.
Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve over 330,000 members in Santa Cruz, Monterey and Merced counties. To learn more about us, click here (http://www.ccah-alliance.org/aboutus.html) or check out this video (https://www.youtube.com/watch?v=yI4SyyIimiU).
At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for sponsorship.
The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status.