Description

Eastern Plumas Health Care is a non-profit, critical access hospital district, providing comprehensive medical services to Plumas County since 1971. We operate a 9 bed acute care hospital at our main Portola campus, which includes a 24 hour, physician staffed, emergency room and ambulance service. In addition, three primary care medical clinics and a dental clinic offer residents a full spectrum of health care services in the Graeagle, Loyalton, and Portola communities. There are also hospital-based Skilled Nursing Facilities in Portola and Loyalton.

Surrounded by the Sierra Nevada Mountains with beautiful lakes and trails for hiking, biking, fishing and skiing, this facility is thriving and wants a highly motivated and experienced Credentialing Coordinator.

Summary:

The Credentialing Coordinator is responsible for the credentialing, re-credentialing, primary source verification, and ongoing monitoring of providers affiliated with Eastern Plumas HealthCare according to applicable accreditation standards, regulatory requirements, policies, and bylaws. This position serves as a resource on credentialing processes and requirements for Eastern Plumas Health Care hospital, rural health clinics, and the health plans. The Credentialing Coordinator is a steward of complete and accurate provider data in the applicable systems and the supporting processes.

The Credentialing Coordinator is providing all aspects of credentialing and re-credentialing of the physicians and advanced practice practitioners for the hospital, rural health clinics and health plans. Research and analyze complex credentialing issues and develop and purpose solutions. Perform ongoing monitoring of physician license status and state and federal sanctions of contracted and non-contracted providers and conducts related investigations.

In this position, the successful candidate will be responsible for ensuring that providers are credentialed, appointed, privileged and any other process required for enrollment with hospitals and patient care facilities. The successful candidate will work collaboratively with a team of skilled professionals, deadline driven environment, demonstrating precision and expertise, in order to maximize efficiency and productivity.

Key Responsibilities:

Act a liaison to State Medical Licensing Boards regarding the status applications. Maintain professional relationships with clinicians, clients and the managers conduct all aspects of third-party credentialing for facilities in accordance to FQHC and third-party insurance standards. Knowledge of facility licensing and program enrollment. FQHC credentialing experience is a plus. Demonstrates effective communication and problem-solving skills.

Required Skills: Knowledge of Health care third party reimbursement programs; such as Medicare, Medi-Cal, Managed Care Health Plans, or private insurance. Completion of new facility licensing renewals, new CLIA/CLR applications, and apply for and update NPI records. Process and file applications with third party vendor according to each vendors individual requirements and addresses/corrects discrepancies as requested by completing rate sets for approved Medi-Cal applications. Renewals of CLIA/CLR applications, Medicare applications for individual providers and facilities (Includes Parts A & B), Medicare revalidations, Medi-Cal and Denti-Cal Applications for locations. Ensure all records meet standards set by carriers as well as FQHC guidelines. Ability to maintain attention to detail. Excellent communication skills; must be able to work in a team environment.

Required Qualifications:

All persons working in a healthcare setting in California are required to have the COVID-19 vaccine. We offer the vaccine free of charge as part of your new hire process.

• NAMSS Certified Provider Credentialing Specialist (CPCS) or CPMSM certification
• Minimum of three (3) years experience in hospital and/or healthcare credentialing.
• Preferred Bachelors degree

Skills:

• Basic knowledge of medical terminology.
• Knowledge of Microsoft products including Excel and Word, eVips
• Database management proficiency required; data entry skills required.
• Detail-oriented, and, understands data system organization.
• Possess strong computational and data analytical skills.
• Customer service oriented; able to interact with physician leadership, staff, and external organizations, including health plans, regulatory agencies, and licensing boards.
• Strong communication skills (both written and verbal).
• Ability to exercise independent critical-thinking and problem-solving skills.
• Ability to maintain a high level of confidentiality.
• Ability to handle stressful situations in a calm, rational manner.
• Ability to prioritize deadline-oriented tasks and handle multiple tasks simultaneously.