Credentialing Specialist, Sharp HealthCare, Kearny Mesa, CA

Posted on August 21st, 2021

The Sharp HealthCare Credentialing Specialist performs and coordinates essential credentialing functions in an effort to attain and maintain quality practitioners in the provider network. Develops credentialing policies and procedures per NCQA standards and other regulatory requirements. Serves as a liaison to delegated entities and vendors to ensure current and adequate credentialing process are in place. Develops and performs queries for data reporting purposes to include directories, hoc reports, and network management reports. Responsible for the maintenance of the provider database and is responsible for providing provider related reports to internal and external entities.

Skills and Qualifications:

• Bachelor's degree in Healthcare Management, Business, or other degree acceptable with a combination of education, managed care, and supervisorial experience
• Requires a minimum of 3 years in the managed care field and 2-year database management
• Excellent written and verbal communication skills
• Excellent organization and interpersonal skills
• Ability to effectively supervise staff activities
• Ability to exercise mature and sound judgement
• Thorough understanding of managed care principle, evolutions, and models
• Familiarity with DMHC and DHS audit requirements as well as NCQA standards for delegation
• Demonstrates courteous, professional, and cooperative behavior toward internal and external customers

Preferred Skills and Qualifications:

• CACTUS credentialing application experience

Location: Kearny Mesa, San Diego County

Compensation and Benefits:
The position provides a very competitive compensation, including opportunity to participate in a management bonus incentive program along with a generous benefit package.

Please note: Unsolicited resumes from employment agencies or other third parties will not be considered.

For a detailed job posting and to apply at:
https://careers.sharp.com/job/san-diego/credentialing-specialist/1031/9259118768

Sharp HealthCare is an Equal Opportunity/Affirmative Action Employer, we celebrate our employees’ differences.  All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, disability, gender, gender identity, transgender status, sexual orientation, protected veteran status, among other things, or status as a qualified individual with disability.