Home > Merced jobs > Merced customer service

Posted: Monday, December 25, 2017 3:52 AM

Job Description:/h3:
Seeking a qualified Credentialing Specialist with experience working with medical provider and practitioner on:boarding processes. Excellent time management, follow:through, and extensive knowledge of TJC and NCQA Standards a must
The Credentialing Specialist provides skilled support to the GVHC credentialing processes and functions.
Essential Duties and Responsibilities
Demonstrates effective communication and problem:solving skills.
Will identify, obtain and verify credentials for all licensed practitioners for initial credentialing and re:credentialing.
Compiles, creates and updates information for use by office staff for the appropriate utilization of specific health plans, IPAs, Managed care, etc., responds to questions for clarification.
Assists medical/dental providers with the credentialing/re:credentialing process in a timely manner including: Hospital appointment/re:appointment of staff privileges, Health plans/IPAs, Managed care organizations, J:1 visa and H:1 B physician, Renewal of licensure, Maintain NPI online provider and clinic site files
Also includes review and follow:up of information submitted, processing of fees, completion of forms, ensures accuracy and detail.
Acts as a resource for patient/staff regarding provider status with various health plans/programs; assists Billing Department with claim issues.
Maintains computerized and hard copy credentialing files for all practitioners
Monitors practitioners enrollment with Medicare/Medicaid and MCOs to ensure proper participation date
Keep Manager informed of concerns or problems with credentialing processes.
Prepare correspondence, memos, and reports as directed.
Project our patient centered culture to the staff, patients and community we serve. Integrate CARE into all aspects of office and professional duties.
Keep up:to:date files of all correspondence, memos, and agreements for department. Organize contacts for accuracy and efficiency.
Handle confidential information and matters of discretion in a professional manner.
Assist with special projects as required.
Min. Qualifications
Knowledge of TJC and NCQA Standards and medical terminology. SKILLS: demonstrated organizational skills; strong working knowledge of Microsoft Word and Excel; written, proofing and composition skills; ABILITY TO: Meet deadlines and prioritize tasks; effectively interact with community, operational and clinical personnel; wide range of creativity and flexibility; plan, organize, coordinate, and monitor the work of committees.
Physical Demands
The employee must occasionally lift and/or move up to 25:50 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Work Environment
The noise level in the work environment is usually quiet.
Education/Experience Requirements
HS Diploma required, AA Degree preferred. Experience may be substituted for education. Minimum of 2 years of health care credentialing experience.

Company Description:/h3:
Golden Valley Health Centers is a Federally Qualified Health Center. With nearly 900 employees in 37 clinics and support centers serving a diverse population, we provide health care services to anyone, regardless of their ability to pay. Just a short drive from beautiful Yosemite National Park and a two hour drive from the Bay Area, GVHC is located in Central California. Affordable cost of living, access to national parks and outdoor activities, quality educational opportunities, and friendly neighbors are just a few of the reasons that make Central California a great place to call home. We offer a competitive benefits and compensation package as well as the opportunity to work with a motivated and growing team.


• Location: atwater, Merced

• Post ID: 25379322 merced is an interactive computer service that enables access by multiple users and should not be treated as the publisher or speaker of any information provided by another information content provider. © 2017