You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.

Job Summary

Our client is seeking a Credentialing Specialist to input and maintain practitioner data in a computer database. The role involves essential credentialing activities related to operations, conducting primary source verification, and ensuring compliance with regulatory requirements.

Key Responsibilities

• Input and maintain practitioner data in the computer database, reviewing, researching, and compiling data for reports.
• Perform credentialing and recredentialing operations, manage inter-departmental contacts, and maintain credentialing status reports.
• Conduct primary source verification on applicants, which includes requests, investigations, tracking, and follow-up of responses.
• Maintain familiarity with NPDB, State Medical Boards, NCQA, and CMS requirements.
• Manage a high volume of internal and external customer inquiries via email, telephone, and in person.
• Collaborate in a team environment and reassess primary job responsibilities as necessary for productivity.
• Act as a liaison between the company, IPAs/Delegates, practitioners, and their staff to ensure excellent customer service.
• Review monthly reports to ensure timely recredentialing and perform projects to improve system integrity.
• Prepare reports on practitioners with adverse actions for the Credentialing Committee and develop meeting materials.
• Maintain strict confidentiality of all practitioner records, data, correspondence, and occurrences.

Qualifications

• 1 year of experience processing provider applications.
• Experience working on the payer side and staying updated on provider credentials is preferred.

Benefits

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
• Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
• 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
• Short Term Disability Insurance.
• Term Life Insurance Plan.

^*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

Medix Overview:

With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.

Any required state or Joint Commission training is compensated at the state or local minimum wage rate.

^*As a job position within our Revenue Cycle division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, handling financial and other payment data, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.