Job Announcement
Position Title: Credentialing Specialist
Department: Billing
Supervised By: Revenue Cycle Manager
Location: Alpine and Campo
Status: Hourly / Non-Exempt
Posted: November 2022
Closing Date: Until Filled
Compensation: $22.43 - $30.89/hr
Grant: N/A
Hours: Full time, Monday-Friday, 8:00AM-4:30PM.

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GENERAL STATEMENT OF RESPONSIBILITIES*: Under general supervision of the Revenue Cycle Manager, the Credentialing Specialist is responsible for processing all initial and recredentialing applications for practitioners seeking staff membership at SIHC with medical, pharmacy, dental, & behavioral health insurance payers. The Credentialing Specialist will assure timely submission of applications and primary source verifications such as provider attestations and provider demographics, provider rosters requested by insurance payers within specified time periods.

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SPECIFIC DUTIES AND RESPONSIBILITIES*:

• To assure timely submission of applications along with required back-up documents within specified time periods.
• Ability to look up information and provide account details or verification of information for providers.

2. Excel spreadsheet.

• Provide other items for applications submitted for credentialing, provider rosters, provider attestations, provider demographics, etc.
• All back-up documents for applications must be organized, saved/scanned as a PDF, and easily accessible by supervisor.

• CAQH (Council for Affordable Quality Healthcare) for initial credentialing and recredentialing required by insurance payers.
• PECOS (Provider Enrollment, Chain, and Ownership System) for initial credentialing and recredentialing of Medicare applicants.
• PAVE (Provider Application and Validation for Enrollment) for MediCal eligible providers to complete credentialing or O/R/P (Ordering/Referring/Prescribing) requirements.
• NPPES (National Plan & Provider Enumeration System) to view or update the NPI (National Provider Identifier) of providers or to acquire a new NPI
• Review credentialing files and work with healthcare providers to obtain missing, incomplete, and expiring items.
• Ability to multi-task effectively with a high level of detail orientation
• Keep contact list, phone numbers, emails, & deadlines current when being requested to credential providers with specific payers
• Maintain consistent contact with healthcare providers to ensure that expectations are clear, and requirements are completed in a timely manner.
• Responsible for maintaining confidentiality of all information.
• Encryption of all emails.

• Ability to work flexible schedule may be required based on need.
• Other duties as assigned.

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QUALIFICATIONS*:

• Education/Experience: Minimum two (2) years or more of relevant credentialing experience with doctors (medical, pharmacy, dental, BH). Experience and proven success in federal and state compliance guidelines in a medical setting. Experience that mirrors a Certified Provider Credentialing Specialist (CPCS), but not required for position. Proficient in Microsoft Office (Excel, Word, Outlook). Must be at least 18 years old.

• Licenses/Certifications: A valid California driver’s license required with application submission and must be maintained throughout employment. Current certifications and/or licenses appropriate to the positions required education and profession.
• Character: Applicants must have a reputation for honesty and trustworthiness. Must be responsible and able to exercise good judgment, accept administrative supervision, pay attention to detail, follow instructions, including the ability to interact effectively and communicate with people in a professional and courteous manner. Must be highly confidential and work as a team with other staff. Applicant should be sensitive to client’s needs.

• Skills: Strong team building, interpersonal, and organizational skills. Ability to establish and maintain effective peer relationships with coworkers within the Billing Department, clinic-wide, and the public. Must be able to express ideas clearly, concisely, address audiences effectively, and exercise balanced judgment in evaluating situations and making decisions. Willing to be part of a team and cooperate in accomplishing department goals and objectives. Ability to prioritize, meet deadlines, take initiative, be proactive, and function in a rapidly changing environment. Ability to work with people of all social and ethnic backgrounds and to resolve conflicts, negotiates situations, and facilitate consensus.

• Physical and Personal Requirements: Normal clinic/office environment. Sit or stand for long periods of time. Reach, bend, climb, stoop, lift up to 25 lbs. repetitive hand movement; use and view PC. Reliable transportation and car insurance as required by the state. Travel as needed.

• Other: Applicants must successfully pass a pre-screening tuberculin skin test or x-ray and a blood/urine drug screening test. Health must be adequate to perform all duties of the position. Applicant must complete SIHC Application and Authorization Form, both must be submitted to Human Resources prior to the close date indicated.

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INDIAN PREFERENCE*:
INDIAN PREFERENCE: In the filling of any SIHC job vacancy, preference may be given to qualified Native American Indians, pursuant to the Indian Preference Hiring Act, 25 USC 472, unless other laws require the filling of a vacancy without regard to Indian preference (e.g. Public Law (P.L.) 94-437, “Indian Health Care Improvement Act (IHCIA). To receive Indian preference for any SIHC position, the applicant must be enrolled, or be eligible for enrollment, as an American Indian with their Tribe, or must be certified as an American Indian from the designated Tribal Representative. Applicants claiming Indian preference must attach verification of their claim to the SIHC application, including Certification of form BIA-4432, which is available from the SIHC Human Resources Department. If verification is not or cannot be verified, the applicant will not receive Indian preference for purposes of the interview.

Job Type: Full-time

Pay: $22.43 - $30.89 per hour

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