Credentialing Liaison

Job Summary: The Credential Liaison is responsible for coordinating, monitoring, and maintaining the credentialing and recredentialing processes. This role supports all aspects of credentialing for HPN/MSOW including Credentialing, Recredentialing, expirable item tracking, and Committee meetings for HVVMG. Act as a liaison between the Health Plan Services and Configuration Departments to ensure all necessary Credentialing data is shared, accurate reports are supplied and all systems match.

Primary Job Duties and Responsibilities:

• Responsible for sending out Initial and Recredentialing applications
• Ensure all applications are reviewed/accurate and all data is entered accurately per Heritage Provider Network’s requirements in MSOW Credentialing Database
• Responsible for Credentialing/Recredentialing of Providers and Facilities including collection of necessary documentation, and primary source verifications required by the National Commission of Quality Assurance (NCQA).
• Run Medicare Opt Out, OIG/OEIE, EPLS, Medical Suspended and Ineligible report, DHCS Restricted Provider List, CMS Preclusion List, Social Security Death Master File and another additional reports required as part of the Credentialing process.
• Responsible for running expirable reports and maintaining current licensure, DEA, Board Certification and Malpractice Insurance in MSOW Credentialing database.
• Ensure all Credentialing (120 days) and Recredentialing (3 yrs) files are completed within the timelines required by NCQA standards.
• Prepare Credentialing/Recredentialing files for Credentialing Committee meetings including accurate completion of Committee checklists and ensure Credentials Chairman has necessary information for all files to present at Credentialing Committee.
• Prepare Agenda and Minutes for Credentialing Committee Meeting.
• Close out Credentialing files following Credentialing Committee including approval letters.
• Maintain Provider and Ancillary rosters with health plans, internal departments and Heritage Provider Network to reflect accurate data.
• Work closely with Health Plan Services department to provide necessary Credentialing documentation required for Health Plan adds, deleted and changes of provider data.
• Notify Configuration Team of newly credentialed provider, changes to providers demographic information and termination for updates in Ez-Cap.
• Work closely with Configuration team to ensure Ez-Cap data and MSOW data match.
• Other Credentialing duties as assigned

Qualifications:

• Education: High school diploma or equivalent - Required.
• Education: Associate degree from accredited institution in the related field of Health Care - Preferred.
• Experience: Minimum 12 months of medical credentialing or related healthcare administrative experience prior to certification – Preferred
• Experience: Experience performing detailed, time-sensitive administrative and clerical processes to support credentialing workflows.
• Experience: Familiarity with ICD-10, CPT, and HCPC coding - Preferred.
• Experience: Ability to perform administrative/clerical in-depth and time-consuming procedures, to obtain flawless medical credentialing.
• Experience: Experience interacting professionally with diverse clientele, including senior management and health plan representatives.
• Knowledge: Understanding of credentialing standards, legal considerations, and regulatory compliance.
• Knowledge: Working knowledge of confidentiality and privacy laws related to healthcare credentialing.
• Knowledge: Understanding of credentialing standards, legal considerations, and regulatory compliance.
• Skills: Strong organizational, analytical, and problem-solving skills.
• Skills: Excellent written and verbal communication abilities.
• Skills: Professional demeanor and ability to handle challenging situations while ensuring compliance with credentialing regulations
• Skills: Proactive with strong follow-up and task completion habits.
• Skills: Effective time management; able to prioritize and manage multiple responsibilities in a fast-paced environment.
• Skills: Team-oriented with the ability to work independently.
• Skills: Proficiency in Microsoft Office (Word, Excel, Outlook); familiarity with credentialing databases - Preferred.
• Driving: Current California driver’s license and proof of auto insurance.
• Other: At the discretion of HVVMG management, this position has the potential to be a full or hybrid telecommuting position

Job Type: Full-time

Pay: $23.66 - $25.36 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Education:

• High school or equivalent (Required)

Experience:

• Credentialing : 1 year (Required)
• healthcare Administration: 1 year (Preferred)

Work Location: In person

Salary : $24 - $25