Akkodis is partnering with a health plan in Central Valley, CA who is looking for Credentialing Specialists for 3-month temporary contracts. 100% remote within CA.
The Terms:
- Temporary 3-month contract
- 100% Remote (Mon-Fri, 8:00-5:00)
- Must be a current resident of CA
- $28/hr W2
- Must have own desktop or laptop to work from
- For this position, applicants must be authorized to work for any employer in the United States. Our client is unable to sponsor or assume sponsorship of an employment Visa at this time.
The Qualifications:
- 1+ years’ experience as a Credentialing Specialist
- Medi-Cal experience
- Managed Care experience preferred
- High School Diploma
- Experience in Excel/Word/Outlook
- Experience taking incoming calls with members and provider offices
- Data Entry experience
Essential Functions:
- Reviews and verifies credentialing and recredentialing documentation submitted by current and potential providers for accuracy, and compliance with policies and other mandated standards; requests information as needed.
- Conducts and obtains credentialing verifications using a variety of internal and external sources; submits completed profiles to Medical Director for review; prepares for submission to Peer Review/Credentialing Committee.
- Researches and facilitates resolution of provider credentialing issues.
- Coordinates the Peer Review/Credentialing Committee meeting by preparing agendas, compiling, assembling, and distributing packets, reviewing minutes for accuracy.
- Follows-up on Action Items generated by the committee members at the Peer Review/Credentialing Committee Meeting.
- Notifies providers of outcomes of credentialing process; notifies appropriate internal and external stakeholders of provider status changes according to established internal timelines.
- Updates and maintains data in appropriate system(s).
- On direction, updates and maintains credentialing policies and procedures to follow established NCQA guidelines; prepares for approval.
Knowledge, Skills, and Abilities:
- Produces work that is accurate and complete.
- Produces the appropriate amount of work.
- Actively learns through experimentation when tackling new problems, using both successes and failures to learn.
- Rebounds from setbacks and adversity when facing difficult situations.
- Knows the most effective and efficient process to get things done, with a focus on continuous improvement.
- In-depth knowledge of credentialing standards, such as DMHC and DHS.
- Basic knowledge of computerized credentialing systems.
- Ability to read, interpret and apply moderately complex written guidelines, instructions and other materials.
- Interpersonal skills - interacts effectively with individuals both inside and outside of the health plan; relates openly and comfortably with diverse groups of people.
- Strong oral and written communication skills, including the ability to communicate professionally and effectively with individuals and groups inside and outside of the health plan.
- Time management and organizational skills. Uses time effectively and efficiently. Values time. Concentrates his/her efforts on the more important priorities. Can attend to a broader range of activities. Meets deadlines.
- Ability to gather and compile data and information and perform simple analysis.
- Good facilitation, problem solving and conflict resolution skills.
- Strong customer service skills.
- Ability to use tact and diplomacy to effectively address sensitive situations.
- Ability to work independently and as part of a team.
- Basic arithmetic skills.
- Basic Windows, Excel and Word skills.
- Type 50 WPM at 90%.
- Ability to speak and be understood in English.
- Ability to handle confidential information with appropriate discretion.
Equal Opportunity Employer/Veterans/Disabled
Benefit offerings include medical, dental, vision, term life insurance, short-term disability insurance, additional voluntary benefits, commuter benefits and 401K plan. Our program provides employees the flexibility to choose the type of coverage that meets their individual needs.Available paid leave may include Paid Sick Leave, where required by law; any other paid leave required by Federal, State or local law; and Holiday pay upon meeting eligibility criteria. Disclaimer: These benefit offerings do not apply to client-recruited jobs and jobs which are direct hire to a client
To read our Candidate Privacy Information Statement, which explains how we will use your information, please visit https://www.modis.com/en-us/candidate-privacy/
The Company will consider qualified applicants with arrest and conviction records.
