Credentialing Analyst; Hybrid Position San Marcos, CA

Position: Credentialing Analyst, (Hybrid Position) San Marcos, CA
True Care is a trusted healthcare provider serving San Diego and Riverside Counties, offering compassionate and comprehensive care to underserved communities. We are committed to making healthcare accessible to everyone, regardless of income or insurance status. With a focus on culturally sensitive, affordable services, True Care aims to improve the health of diverse communities. Our vision is to be the premier healthcare provider in the region, delivering exceptional patient experiences through innovative, integrated care.

The Credentialing Analyst plays a vital role in ensuring that all healthcare providers and licensed or certified staff are properly credentialed and in compliance with internal standards and external regulatory requirements. The position is responsible for end-to-end credentialing and recredentialing processes and maintaining and updating the credentialing software systems.

Responsibilities:

• Responsible for processing the initial and re-appointment applications.
• Ensure all licensed or certified staff are privileged and proctored as deemed appropriate.
• Verify and maintain the credentials of healthcare providers ensuring compliance with industry standards.
• Work closely with the Sr. Medical Staff Director and make recommendations to improve credentialing and privileging processes.
• Maintain the MD-Staff credentialing software system, ensuring accuracy and timely information.
• Notify all health plan entities of any provider change such as termination or update in business address.
• Work with the Provider Enrollment Specialist and ensure all health plan enrollments are processed.
• Querying National Practitioner Data Bank (NPDB) for OCLPs at initial and/or during re-appointment.
• Communicate with providers, staff, and other stakeholders to address inquiries and resolve issues.
• Escalate all non-compliance with licensure, certification, and re-appointment.
• Analyze verification documents to identify discrepancies or inconsistencies.
• Identify errors, omissions, or incongruencies in provider credentialing information.
• Investigate complaints against providers.
• Maintain current Pro Assurance malpractice certificates and secondary non True Care liability insurance.
• Ensure that credentialing practices adhere to organizational standards, NCQA, state or other regulatory agency guidelines.
• Track and monitor credentialing deadlines, ensuring timely renewals and compliance.
• Providing guidance to other credentialing staff.

Qualifications:

• Associate's degree in Business, Healthcare Administration or related field.
• 4 to 5 years' experience with the credentialing and privileging process for licensed independent providers (LIPs).
• Strong organizational skills and attention to detail.
• Possesses solid working knowledge of subject matter.
• Experience with primary source verifications and collections of credentialing and privileging documentation.

Preferred Qualifications:

• Bachelor's Degree preferred.
• MD-Staff Credentialing Software knowledge.
• Certified Provider Credentialing Specialist (CPCS).
• Experience in healthcare or working in a Federally Qualified Health Center.

Benefits:

• Competitive Compensation
• Competitive Time Off
• Low-cost health, dental, vision & life insurance
• Tuition Reimbursement, Employee Assistance program

The pay range for this role is $29.99 - $43.48 on an hourly basis.

Pay transparency:
If you are hired at True Care, your salary will be determined based on factors such as education, knowledge, skills, and experience. In addition to those factors, we believe in the importance of pay equity and consider the internal equity of our current team members when determining an offer.

True Care is committed to a policy of Equal Employment Opportunity and will not discriminate against an applicant or employee on the basis of any characteristic protected by applicable federal, state, or local law. Our goal is to support all team members recruited or employed here.

Compensation details:  Hourly Wage

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