Position Overview: Responsible for credentialing and recredentialing practitioners and facilities in accordance with PacificSource policies and procedures, ensuring compliance with National Committee for Quality Assurance (NCQA) standards and state and federal regulatory bodies. Participate in the development and implementation of credentialing policies and procedures to ensure timely, accurate credentialing of medical practitioners and facilities affiliated with PacificSource. Responsible for the ongoing maintenance of files, preparation of files for credentialing committee, as well as electronic database input and management. Communicate directly with practitioners and facilities on credentialing issues and medical practice information.
Maintain familiarity with PacificSource credentialing policies and procedures, National Practitioner Data Bank (NPDB) reporting requirements, State Medical Board policies, NCQA credentialing standards, and state and federal regulatory credentialing requirements. Attend workshops and seminars to increase and maintain knowledge as necessary.
Participate in the training and orientation of new hires.
Meet department and company performance and attendance expectations.
Perform other duties as assigned.
Work Experience: Minimum three years credentialing experience in the credentialing field and/or equivalent experience.
Education, Certificates, Licenses: High School Diploma or equivalent required. NAMSS Certified Provider Credentialing Specialist Certification (CPCS) preferred.
Knowledge: Effective written and verbal communication skills. Must be highly organized and possess strong interpersonal skills. Knowledge of NCQA credentialing standards as well as state and regulatory credentialing requirements. Knowledge of policy and procedure development. Knowledge of requirements and functions of the Credentialing Committee and how it contributes to the credentialing functions. Maintain regular contact with PacificSource Provider Network Management Department to update current practitioner information. Computer skills, including word processing, spreadsheet, database applications and medical terminology.
Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time.
Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.
PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.