Position: Credentialing Specialist

• Hybrid: Remote & In-office (as needed)

This position reports to the Director of Provider Services and is responsible for full cycle credentialing of Providers and Facilities. Position must have experience with facility credentialing of Hospitals, SNF, Home Health, Radiology etc. The role will work closely with new client implementation and will assist regularly with transitioning Credentialing file of new clients moving from one MSO to another. This position requires strong organization skills, attention to detail, able to identify issues and recommend solutions. Implementation will require thorough auditing of already approved files to ensure system data matches file and reviewing files for errors that will impact Health Plan audit. The Specialist will have oversite to ensure Provider Rosters can be pulled, Re-credentialing timeframe are met and CAQH accounts are setup and maintained. Credentialing Specialist will assist in preparing files for pre-delegation and annual audits, monitoring of providers and entities. This position will also work closely with Quality and will require some travel when Facility Site Reviews are required.

Some Major Duties Include:

• Auditing Credentialing files for delegation oversight and new client implementation.
• Organizing files and ensuring Provider and Facility data is accurately entered into the database while validate all key elements required for Credentialing and Provider Rosters.
• Ability to set up workflows for sharing files between clients auditors, CAQH.
• Review initial paperwork and applications to identify possible issues and follows up with the healthcare provider as needed to obtain any missing or request additional information.
• Performs primary source verifications to ensure properly licensed, trained and certified as mandated by the state and federal regulations and monitor Providers for adverse events while staying in front of the expiration of credentials and privileges.
• Review of hospital privileging, run quality reports and review reappointment applications
• Run reports for various departments, assist with identification on network deficiency, and periodically audit files, conduct internal reviews and ensure all files are current and audit ready.
• Establishes and maintains positive and close working relationships with internal and external stakeholders.
• Prepare and conduct Credentialing Committees.
• Participates in staff meetings and continuing education, and recommends new approaches, opportunity for automation and data migration, review policies, and procedures and recommend continual improvement in efficiency of the department and services performed.
• Travelling to providers’ offices may be required for credentialing purposes.
• Troubleshooting and making phone calls that pertain to Credentialing and/or Provider Service Department.
• Other duties and projects assigned.

Position

• Full Time, Benefits Eligible
• Non-Exempt
• Hybrid: Remote & In-Office (as needed)

Pay

• $25 - $31 per hour or Competitive Compensation

IMS offers competitive compensation. We are an equal opportunity employer and seek diversity in our workforce.

Our Company

Our team at IMS is looking for highly motivated and resourceful individuals to join our growing start-up. We strive to innovate the healthcare industry by providing management and consulting services to healthcare entities, including healthcare facilities, medical groups, providers, and suppliers. Using our wide-ranging experience and comprehensive knowledge of the healthcare industry, our team works to provide quality services and customer care to our clients and their Medicare beneficiaries. By working at IMS, you’ll gain an in-depth perspective of the managed care industry and share in the professional development of our expanding company. Take initiative and ownership of your projects to make a difference and go the extra mile! We welcome you to apply to join our team!

Education

• Associate degree or equivalent experience.
• Bachelor's Degree preferred, and/or equivalent experience in healthcare administration, management service organization, health plan, and/or IPA.

Certifications/Licenses

• Active and Valid Driver's License and unexpired car insurance.
• Certified Provider Credentialing Specialist certification (CPCS) by National Committee for Quality Assurance (NCQA), preferred.

Experience

• 3-5 years in healthcare administration, management service organization, health plan, and/or IPA.
• Facilities credentialing experience, required.

Knowledge/Skills/Abilities/Other Attributes

• Excellent communication skills.
• Accurate data entry and proficient computer skills.
• Quick learner and ability to adapt to fluctuating priorities.
• Strong organizational skills.
• Knowledge in credentialing and re-credentialing process.
• Knowledge in facilities credentialing process.
• Ability to interact with physicians, contractors, and all levels of management.
• Always maintain strictest confidentiality.
• Knowledge of federal and state laws and compliance regulations, such as HIPAA.
• Excellent Customer Service and Multitasking skills
• Be able to travel to our office location in City of Industry office and to other clients' offices and business affiliates as needed.

• Please note that the duties and responsibilities outlined above are summarized and may not encompass all tasks associated with the position. The nature of the role may require adaptation to changing circumstances and additional responsibilities not explicitly mentioned here. The organization reserves the right to modify, interpret, or supplement the job duties as needed.