Located in the heart of the Coachella Valley, you have access to resort-style living and world-class amenities throughout Southern California.
Job Objective:
Assists with payer credentialing of Eisenhower Medical Associates (EMA) and Eisenhower Health Foundation physicians and advanced practice providers (APPs).
Job Description:
Education:
Required: High school diploma, GED or higher level degree Preferred: Associate's degree
Licensure/Certification:
N/A
Experience:
Required: Three (3) years of experience in healthcare scheduling, billing or insurance Preferred: Experience in healthcare payer credentialing
Essential Responsibilities:
- Demonstrates compliance with Code of Conduct and compliance policies and takes action to resolve compliance questions or concerns and report suspected violations.
- Assists with the initial and renewal credentialing with Medicare and other third party health plans for all EMA and Eisenhower Health Foundation providers (APP).
- Obtains required information from providers for credentialing with Medicare and other third party plans.
- Creates and maintains the credentialing files for each provider including but not limited to, personal, practice, education, and malpractice information.
- Assists the Payer Credentialing Coordinator by working with payers to ensure all required credentialing information is submitted and processed accordingly.
- Assists in following up with Medicare and third party payers to confirm completion of credentialing, as instructed by Payer Credentialing Coordinator.
- Updates CAQH database for third party payers.
- Develops and updates Provider rosters for payers and clinic administration.
- Assists in answering correspondence from health plans for updates or new information in a timely manner, as instructed by Payer Credentialing Coordinator.
- Validates provider information on payer websites on a regular basis.
- Participates and contributes to quality improvement activities of the department.
Essential Skils:
- Written and verbal communication skills
- Ability to prioritize tasks and manage time efficiently to meet deadlines
- Ability to use Microsoft Office Suite (Word, Excel, Outlook, PowerPoint) and other relevant software applications
- Ability to adapt quickly to changing priorities and unexpected situations
