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Credentialing Specialist, South San Francisco, CA


Organization: Health Plan of San Mateo
Category: Professional
Location: South San Francisco, CA
Date Job Posted: January 10, 2020
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CREDENTIALING SPECIALIST

The Health Plan of San Mateo (HPSM), a managed care health plan, seeks a full time Credentialing Specialist. Serve as the focal point for HPSM’s credentialing process to outside parties. Oversee the Health Plan of San Mateo’s (HPSM) credentialing process, ensure that contracted providers maintain compliance with HPSM’s credentialing requirements, and make recommendations for improvements to the credentialing process.

The essential duties and responsibilities will include the following:

  • Research, analyze, and evaluate credentialing applications, ensuring all relevant information has been submitted; distribute and receive the application.
  • Ensure credentialing applications are tracked and monitored for adherence to timelines.
  • Enter demographic and credentialing information into credentialing software in a timely and accurate manner.
  • Monitor and document credentialing efforts.
  • Maintain a current copy of and quickly learn/understand HPSM’s credentialing policies and procedures, ensuring that policies and procedures are followed and that applications and reapplications are processed thoroughly and expediently.
  • Create and construct files; prepare files for review.
  • Assemble relevant data and prepare scheduled and ad-hoc reports as needed.
  • Ensure re-credentialing of providers according to policies and procedures
  • Continuously improve credentialing process.
  • Make recommendations on improvements to the credentialing policies and procedures, based on experiences and/or evolving regulatory requirements (i.e. state contract, Knox-Keene requirements, NCQA guidelines).
  • Perform other duties as assigned.

Requirements

Education and Experience:

Two (2) years of work in a clerical/administrative function in a health services/managed care setting. A Bachelor’s degree in an appropriate health or business field and credentialing experience is preferred.

Knowledge of:

Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, and PowerPoint. Medi-Cal and Medicare preferred.

Ability to:

Work cooperatively with others. Work as part of a team and support team decisions. Communicate effectively, both verbally and in writing. Adapt to changes in requirements/priorities for daily and specialized tasks. Work in a fast- paced, highly pressured, and changing environment. Compile, verify, and follow-up on information. Quickly learn the credentialing process and software. Create basic reports. Be resourceful and use initiative to resolve problems/issues. Communicate effectively with others, both verbally and in writing. Accurately perform highly detailed work. Organize/prioritize tasks. Deliver results within set deadlines. Attend meetings outside of regular work hours as necessary.

Compensation and Benefits

Starting Compensation Range: - Depending on Experience

Benefits Information: Excellent benefits package offered, including HPSM paid premiums for employee’s Medical, Dental and Vision coverage. Employee pays a small portion of the dependent premiums (5%) for medical and dental benefits. Additional HPSM benefits include fully paid life, AD&D, and LTD insurance; retirement plan (HPSM contributes equivalent of 10% of annual compensation); holiday and vacation pay; tuition reimbursement plan; onsite fitness center and more.

How to Apply

Application Process: To apply, submit a resume and cover letter with salary expectations to: Health Plan of San Mateo, Human Resources Department, 801 Gateway Blvd., Suite 100, South San Francisco, CA 94080 or via email: careers@hpsm.org or via fax: (650) 616-8039. File by: Continuous until filled. The Health Plan of San Mateo is proud to be an Equal Opportunity Employer and encourages minority candidates of all backgrounds to apply.

Submissions without a Cover Letter and Salary Expectations may not be considered.


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