Job Description

Job Description

Job Description

We are looking for a meticulous Credentialing Specialist to join our team in Palm Springs, California, for a long-term contract position. In this role, you will play a vital part in ensuring healthcare providers meet all credentialing and compliance standards, with a focus on California-specific regulations and managed care requirements. This opportunity is ideal for detail-oriented professionals who thrive in a collaborative and fast-paced environment.

Responsibilities:
• Oversee initial credentialing and recredentialing processes for healthcare providers in managed care networks.
• Verify licenses, certifications, education, and work history to ensure compliance with state and national regulations.
• Maintain up-to-date knowledge of managed care policies and credentialing requirements, including Medicare and Medicaid standards.
• Monitor adherence to California-specific licensing laws and guidelines from accrediting organizations such as The Joint Commission.
• Manage accurate databases for provider credentialing files, including tracking expiration dates and conducting audits.
• Act as a liaison between healthcare providers, managed care organizations, and regulatory agencies to facilitate clear communication.
• Handle renewals and appeals related to credentialing errors or provider denials in accordance with state laws.
• Identify and implement process improvements to streamline credentialing workflows and enhance efficiency.
• Stay informed about changes in healthcare regulations and adjust processes accordingly.• Associate’s or Bachelor’s degree in healthcare administration, business, or a related field, or equivalent work experience.
• Minimum of 2-3 years of experience in credentialing, preferably within a managed care or California-based healthcare organization.
• Proficiency with credentialing software and electronic medical record systems such as Cerner and Epic.
• Strong knowledge of California healthcare credentialing laws and standards from accrediting organizations.
• Exceptional attention to detail and organizational skills to manage complex documentation.
• Excellent verbal and written communication skills for effective collaboration.
• Ability to prioritize multiple tasks and work efficiently under deadlines.
• Certification as a Certified Provider Credentialing Specialist (CPCS) is preferred but not required.

Job Tags

Work experience placement, Long term contract,

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