Posted in General Business 30+ days ago.
Type: Full-Time
Job Summary
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This position performs and supervises credentialing and recredentialing activities according to Prospect Medical Credentialing Policies, contracted health plan policies, CMS, state law, and NCQA accreditation guidelines.
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Credentialing & Recredentialing
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\"Location-Based Pay Adjustment\" With approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Texas and Rhode Island. Our extensive care services range from primary care and specialty physician services to acute care hospital and skilled nursing facilities to behavioral health and wellness services. Each of our Independent Physician Associations (IPAs) and networks support the use of advanced diagnostic and treatment tools to provide our members with convenient access to state-of-the-art healthcare. For 25+ years, Prospect Medical has been focused on our mission of supporting independent physicians where, through risk arrangements, we work closely together with health plans, facilities and healthcare physicians for the benefit of every person who comes to us for care. We provide quality healthcare services that are designed to offer our patients highly coordinated, personalized care and that help them live healthier lives. Prospect Medical Systems manages highly successful IPAs by leveraging our best-practices, results-driven administrative services to manage patients under risk arrangements with health plans/CMS.Previous experience in auditing, Experience with Excel and Access, Astute problem solving skills, Ability to read and comprehend contracts. In depth knowledge of Morrisey and CDA with previous credentialing experience.High School Diploma or GEDResponsible for training all new employees for the first 30 days of employment. Responsible for creating and implementing training material for the Provider Information Management and Credentialing department to all employees are trained in a consistent manner for PIM and Credentialing, to include but not limited to Morrisey, CDA, and Sanator.|Audit new employees work prior to completion within 30 days.
Review PID retrieval and re-submission process.
Review Change Forms on CDA, Morrisey reports, emails submitted to health plans.|Review of rosters submitted to health plans.|Educates and updates the PIM/Credentialing Department on new guidelines. Resource for training, education and coordination of improvements and additions. Attend weekly meetings.Responsible for training all new employees for the first 30 days of employment. Responsible for creating and implementing training material for the Provider Information Management and Credentialing department to all employees are trained in a consistent manner for PIM and Credentialing, to include but not limited to Morrisey, CDA, and Sanator.|Audit new employees work prior to completion within 30 days.
Review PID retrieval and re-submission process.
Review Change Forms on CDA, Morrisey reports, emails submitted to health plans.|Review of rosters submitted to health plans.|Educates and updates the PIM/Credentialing Department on new guidelines. Resource for training, education and coordination of improvements and additions. Attend weekly meetings.
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