Job description

This position is remote for those who live San Diego, CA

POSITION SUMMARY

• Reviews credentialing applications for completeness, completes primary source verification and prepares applications for committee review. Maintains credentialing database on all credentialed providers.

JOB DUTIES

• Reviews credentialing applications for completeness, and scans into database. Obtains current copies of medical license, DEA license and malpractice insurance and verifies with appropriate agency.
• Complete primary source verification on all initial applicants and on all providers at time of re-credentialing within 180 days of application being signed.
• Maintains credentialing database on all credentialed providers, updates information upon completion of re-credentialing, and as various documents expire.
• Prepare credentialing packets for each Medical Group’s board meetings so review can be made within 180 days of application being signed.
• Sends out initial credentialing packets to potential new providers, as directed. Sends out re-credentialing packets to providers 90 days prior to re-credentialing due date. Follows up with providers when applications are not returned timely.
• Pulls credentialing files, reviews and prepares files for health plan delegation audits. Runs ad hoc reports from available databases.

POSITION QUALIFICATIONS AND REQUIREMENTS

Experience/Specialized Skills:

• Prior physician credentialing experience. Proficient with computer, Microsoft windows environment.

Education/Course(s)/Training:

• Associate degree preferred.

ADDITIONAL POSITION EVAULATION FACTORS

Impact of Decisions:

• Compliance with credentialing policies and procedures to maintain delegation for credentialing with the contracted health plans on behalf of the medical groups.

Internal/External Contacts:

• Internally interacts with all levels of the organization. Externally interacts with physicians, physician’s office staff, and health plan staff.

Work Schedule:

• Monday - Thursday
• 10 Hour shift
• 3-day weekends EVERY weekend!

View our company website to learn more about the company and career opportunities. You may apply through company website or through Indeed.

www.scpmcs.org

SCPMCS is an Equal Opportunity Employer

Job Type: Full-time

Pay: $19.69 - $24.12 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule:

• Day shift

Ability to commute/relocate:

• San Diego, CA 92121: Reliably commute or planning to relocate before starting work (Required)

Application Question(s):

• What job related software do you have experience in?
• What is your salary expectation?
• What is your interview availability?

Education:

• High school or equivalent (Preferred)

Experience:

• Physician credentialing: 1 year (Preferred)
• primary source verification: 1 year (Preferred)
• maintaining credentialing: 1 year (Preferred)
• health plan audit: 1 year (Preferred)
• Microsoft Office: 1 year (Preferred)

Work Location: Remote

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