Credentialing Specialist

Job ID
2021-163264
Employment Type
Full Time
Department
Credentialing
Hours / Pay Period
80
Facility
Dignity Health Management Services Organization
Shift
Day
Standard Hours
Mon-Fri (8-5 PM)
Work Schedule
8 Hour
Location
CA-Redlands

Overview

The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.

Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art, flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options, including medical, dental and vision plans, for the employee and their dependents, Health Spending Account (HSA), Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.

Responsibilities

Responsible for all credentialing activities associated with all IPAs and product lines managed by DHMSO. Works with Credentialing Supervisor, Medical Directors, Provider Relations Department, Contracting Department, health plans, providers, provider office staff, and other persons or businesses as necessary to ensure that all providers are properly credentialed according to NCQA and health plan standards. Where appropriate, makes recommendations regarding improvement of processes and procedures.

Qualifications


    Minimum


  • High school diploma or GED required.


  • Three to five years of experience in the healthcare industry required, preferably with experience in credentialing.


  • Strong written and verbal communication skills, excellent organizational skills, and proficient in Microsoft Word, Excel, and Microsoft Outlook.


  • Self-directed and able to work independently under tight time frames.


  • Able to interact with co-workers, man



  • Preferred


  • One or more years of vocational or college coursework preferred.


  • CPCS or CMSC, or progressing towards certification preferred.



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