Credentialing Specialist

Job Number: 7136

Workplace Type: Fully Remote

Position Title: Credentialing Specialist

External Description:

Overview of the Role:

Alignment Health is seeking an organized and detail oriented credentialing specialist to join the credentialing team. As a credentialing specialist, you are responsible for all aspects of credentialing and re-credentialing for providers, including physicians and healthcare delivery organizations as required. You get to prepare and maintain reports of credentialing activities such as licensure, accreditation, membership or facility privileges. You will also ensure all information meets federal and state guidelines when processing applications as well as maintaining all the records and documentation of the application and verification process. The credentialing specialist works with the providers to maintain current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents as well as maintaining up-to-date data for each provider in credentialing databases and online systems including CAQH.

If you are hungry to learn and grow, want to be part of an expanding healthcare organization, and are passionate about positively impacting the lives of seniors, we're looking for YOU!

Responsibilities:

• Review practitioner and organizational provider credentialing and recredentialing applications for completeness.
• Identify and flag adverse information from provider application materials and perform follow-up investigations.
• Collect, review, and verify provider credentials, including licenses, certifications, education, and work history.
• Coordinate with internal departments and external entities to obtain necessary documentation and information.
• Respond to inquiries from providers regarding their credentialing status.
• Access external websites collecting data for completion of the application process.
• Responsible for the internal data system provider file origination and maintenance and all associated documents storage functions.
• Communicate with credentialing vendors as needed
• Ensure application complies with NCQA and CMS requirements
• Prepare provider and HDO credentialing and re-credentialing files for committee review
• Prepare summary packets for Credentialing Committee review on files not meeting the Clean File Criteria.
• Responsible for health plan provider-related communications.
• Responsible for data accuracy in Credentialing Database and Provider Network application for credentialed contracted providers.
• Know how to process provider applications for hospital privileges for internal staff.
• Maintain good communication with office staff, CVO, hospital staff and physicians. maintains excellent team working skills and working outside of job description if necessary
• Respond to internal and external customer inquiries regarding credentialing status

Requirements:

• Minimum 1 year experience in the field of credentialing in a healthcare environment
• Knowledge of Medicare and Medicare Application processing requirements
• High school diploma, GED, or equivalent
• Some college education a plus
• Certified Provider Credentialing Specialist (CPCS) Credentialing Certificate a plus or willingness to obtain when eligible
• Excellent written and verbal communication skills
• Highly detail oriented
• Proven follow-up skills
• Advanced computer skills including Microsoft Word, Excel, and PowerPoint

City: Remote-US

State: California

Location City: Remote-US

Location State: California

Community / Marketing Title: Credentialing Specialist

Company Profile:

Alignment Health is revolutionizing health care for seniors by leveraging our world-class technology platform, innovative care delivery models, deep physician partnerships and our serving heart culture! From member experience professionals and clinicians, to data scientists and operations leaders, we have built a talented and passionate team that is deeply committed to our mission of transforming health care for the seniors we serve. Ready to join us?

At Alignment Alignment, delivering exceptional care to seniors starts with ensuring an exceptional experience for our over 1,300 employees. At the center of our employee experience is a culture where employees at all levels and across all teams are encouraged to share their unique ideas and perspectives. After all, when you can bring your authentic self to work, whether that’s in a clinical setting, our corporate office or a home office, creativity and innovation flourish! Another important part of the Alignment culture is a belief in continuous learning and growth. As a result, in this fast-growing company, you will find ample support to grow your skills and your career – with us.

EEO Employer Verbiage:

 Please note: All clinical positions are contingent upon successful engagement with Alignment Health’s COVID-19 Vaccination program (fully vaccinated with documented proof or approved exception/deferral).

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].