Primary responsibility for obtaining timely physician credentials with third party payers including, but not limited to, PPOs, Medicare, Medi-Cal, Railroad Retirement, TriCare and others. In addition, this position is responsible for maintaining and renewing credentials for physician clients monitoring expiration dates and renewal dates. This position assists the Director in obtaining payer contracts from PPOs for client practices.
Essential Functions and Responsibilities of the Job
Obtain and maintain physician data in IntelliApp system to produce CAPP and CAQH applications for physician credential programs
Prepare payer specified applications for new credentials or recredentialing of physician clients
Maintain tracking mechanism for submitted applications with established follow-up procedures for incomplete credentialing applications.
Notify relevant departments and parties of approved credentials when received from payers.
Maintain knowledge of payer mechanisms for credentialing process and provide requested data consistent with those mechanisms.
Remain current in regulatory matters surrounding credentialing particularly with regard to Medicare and other public payer programs
Maintain physician information in a secure and confidential manner so as to minimize such information being released to unauthorized persons
Provide reports on credentialing status no less than weekly or as may be requested.
Assist the Director with information that may be needed for obtaining contracts on behalf of physicians with third party payers.
Complete other duties as may be assigned from time to time.
2 years experience in physician credentialing or 3 years experience in patient accounts with some experience in provider/payer credentialing.
Proficient in MS Word and Excel plus ability to learn proprietary credentialing software.
Experience and knowledge of IntelliApp is preferred.
Proven and excellent customer relations skills, and the ability to communicate effectively with physicians and executives.
Ability to use tools to maintain organization of critical physician information for credentialing purposes.
High school graduate or equivalent
Internal Number: MEM003347
About MemorialCare Medical Foundation
Let us introduce ourselves. We're MemorialCare, a nonprofit health system that includes four hospitals, two medical groups, imaging centers, surgical centers and much more. As one of the leading health systems in Orange County and Los Angeles County, we're confident that no matter what your needs are, we have the teams, tools and know-how to support you every step of the way.