Credentialing Specialist

***This position is work from home within the Greater Sacramento, CA region.

Position Summary:

Under minimal supervision and by applying expertise and individual judgment, the Credentialing Specialist is responsible for ensuring the credentialing program and all related credentialing, recredentialing and privileging functions are maintained in accordance with policy, NCQA, CMS, AAAHC, URAC and IMQ accreditation and health plan regulatory standards. The Credentialing Specialist works in conjunction with the Director, Credentialing and Payer Enrollment, Chief Medical Officers and the Director, Quality Management in the development, coordination, implementation and management of a comprehensive credentialing program. The Credentialing Specialist ensures the organization and medical groups meet health plan and government regulatory requirements, including delegated functions pertaining to credentialing, credential file auditing, organizational provider credentialing, organizational provider auditing, primary source verification, etc. They consult and collaborate with physicians and operational leaders on credentialing related issues and potential credentialing related provider contract terminations. 

The Credentialing Specialist coordinates/supports Dignity Health Medical Foundation and medical group credentialing committees to meet the organizations' bylaws, administrative policies, health plan contractual requirements and committee charters. They ensure interdepartmental compliance with policies that support onboarding, credentialing, recredentialing, privileging and network management functions. Manages and has access to provider Protected Personal Information (PPI) and Protected Health Information (PHI) and maintains the confidentiality of same at all times. Must be willing to register for access to confidential government databases, including the notarization of registration documents. Such registration may require providing confidential personal information. Occasional travel to locations for meetings and audits and any other duties as assigned to support Credentialing and Payer Enrollment initiatives and projects.

Minimum Qualifications:

• Three (3) years experience in credentialing or closely related healthcare administration experience required
• High School diploma or equivalent 
• Requires:
• Demonstrated knowledge of credentialing and privileging principles, concepts, standard and regulations 
• Excellent analytical and organizational skills required. Highly detail oriented, creative and proven problem solver
• Strong attention to detail and ability to analyze 
• Strong project management, problem resolution and communication skills 
• Excellent organizational skills and ability to prioritize workload in ever changing environment
• Strong MS Office Suite skills (Word, Excel, PowerPoint and SharePoint) and proven ability to learn/use company specialized software and hardware
• Strong work ethic and high degree of professionalism
• Motivation, energy and ability to work both independently and collaboratively

Preferred Qualifications:

• AA degree preferred
• Three (3) years of prior multi-specialty physical medical group and credentialing experience with health plans
• Current CPCS (Certified Provider Credentialing Specialist) certification preferred

Dignity Health Medical Foundation, established in 1993, is a California nonprofit public benefit corporation with care centers throughout California. Dignity Health Medical Foundation is an affiliate of Dignity Health - one of the largest health systems in the nation - with hospitals and care centers in California, Arizona and Nevada. Today, Dignity Health Medical Foundation works hand-in-hand with physicians and providers throughout California to provide comprehensive health care services to the many communities we serve. As Dignity Health Medical Foundation continues to grow and establish new premier care centers, we provide increasing support and investment in the latest technologies, finest physicians and state-of-the-art medical facilities. We strive to create purposeful work settings where staff can provide great care, while advancing in knowledge and experience through challenging work assignments and stimulating relationships. Our staff is well-trained and highly skilled, qualities that are vital to maintaining excellence in care and service.