Dignity Health Credentialing Specialist in Rancho Cordova, California
Dignity Health Medical Foundation, established in 1993, is a California nonprofit public benefit corporation with care centers throughout California. Dignity Health Medical Foundation is an affiliate of Dignity Health - one of the largest health systems in the nation - with hospitals and care centers in California, Arizona and Nevada. Today, Dignity Health Medical Foundation works hand-in-hand with physicians and providers throughout California to provide comprehensive health care services to the many communities we serve. As Dignity Health Medical Foundation continues to grow and establish new premier care centers, we provide increasing support and investment in the latest technologies, finest physicians and state-of-the-art medical facilities. We strive to create purposeful work settings where staff can provide great care, while advancing in knowledge and experience through challenging work assignments and stimulating relationships. Our staff is well-trained and highly skilled, qualities that are vital to maintaining excellence in care and service.
Under minimal supervision and by applying expertise and individual judgment, the Credentialing Specialist is responsible for ensuring the credentialing program and all related credentialing, recredentialing and privileging functions are maintained in accordance with policy, NCQA, CMS, AAAHC, URAC and IMQ accreditation and health plan regulatory standards. The Credentialing Specialist works in conjunction with the Director, Credentialing and Payer Enrollment, Chief Medical Officers and the Director, Quality Management in the development, coordination, implementation and management of a comprehensive credentialing program. The Credentialing Specialist ensures the organization and medical groups meet health plan and government regulatory requirements, including delegated functions pertaining to credentialing, credential file auditing, organizational provider credentialing, organizational provider auditing, primary source verification, etc. They consult and collaborate with physicians and operational leaders on credentialing related issues and potential credentialing related provider contract terminations.
The Credentialing Specialist coordinates/supports Dignity Health Medical Foundation and medical group credentialing committees to meet the organizations' bylaws, administrative policies, health plan contractual requirements and committee charters. They ensure interdepartmental compliance with policies that support onboarding, credentialing, recredentialing, privileging and network management functions. Manages and has access to provider Protected Personal Information (PPI) and Protected Health Information (PHI) and maintains the confidentiality of same at all times. Must be willing to register for access to confidential government databases, including the notarization of registration documents. Such registration may require providing confidential personal information. Occasional travel to locations for meetings and audits and any other duties as assigned to support Credentialing and Payer Enrollment initiatives and projects.
Associate degree (or equivalent experience and education) required
Three (3) years experience in credentialing or closely related healthcare administration experience required
Demonstrated knowledge of credentialing and privileging principles, concepts, standard and regulations
Excellent analytical and organizational skills required. Highly detail oriented, creative and proven problem solver
Strong attention to detail and ability to analyze
Strong project management, problem resolution and communication skills
Excellent organizational skills and ability to prioritize workload in ever changing environment
Strong MS Office Suite skills (Word, Excel, PowerPoint and SharePoint) and proven ability to learn/use company specialized software and hardware
Strong work ethic and high degree of professionalism
Motivation, energy and ability to work both independently and collaboratively
Bachelor degree preferred
Three (3) years of prior multi-specialty physical medical group and credentialing experience with health plans
Current CPCS (Certified Provider Credentialing Specialist) certification preferred
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If you need a reasonable accommodation for any part of the employment process, please contact us by telephone at (415) 438-5575 and let us know the nature of your request and your contact information. Requests for accommodation will be considered on a case-by-case basis. Please note that only inquiries concerning a request for reasonable accommodation will be responded to from this telephone number.
Job ID 2018-62664
Employment Type Full Time
Hours / Pay Period 80
Facility Dignity Health Medical Group Region
Location Rancho Cordova
Standard Hours Monday - Friday, 8:00 AM - 5:00 PM
Work Schedule 8 Hour