Sutter Health Credentialing Coordinator-HR Physician Services Credentialing-Mountain View in Mountain View, California

Description

Job Summary:

Under minimal supervision, this position may be responsible for the following:

•Processing initial credentialing and/or recredentialing applications for PAMF, PAFMG and MPMG providers as well as contracted ancillary organizations.

•Maintaining ongoing health plan communications including directory verifications.

•Processing initial Medicare and Medi-Cal enrollment applications as well as trouble shoot enrollment related billing issues with Sutter Physician Services

(SPS) as needed.

Principal Accountabilities:

Process and complete initial credentialing applications for new providers (physicians, advanced practice clinicians and other allied health professionals) according to established standards and policies and ensuring the application is complete and required documents have been submitted with the application. 95% of all initial applications should be completed within a 60 day turnaround time (from the time the app is sent to the provider and the application is approved by the Credentials Committee). The ability to meet the 60 day turnaround time requires coordination with the applicant and the S3 CVO to ensure all required documentation is received and processed in a timely manner. In addition, you will follow up on discrepancies and/or issues found during the credentialing process. Requires ability to identify questionable and/or highly sensitive information. Coordinates with Recruiting staff, Provider Services Directors, Managed Care Contracting and/or Human Resources for a smooth on boarding of all new hires and contracted providers.

Maintains the standard tracking log in order to stay on track, have details available to answer questions regarding status and to allow transparency of metrics.

May also be responsible for the required administrative process in Mills Division including MPMG Board approval and set up in Tapestry using the “SuperForm”.

*Recredentialing

As needed, process and complete recredentialing applications for physicians, advanced practice clinicians and other allied health professionals according to established standards and policies and ensuring the applications are completed within established recredentialing cycles. Follows up on discrepancies and/or issues found during the recredentialing process. Requires ability to identify questionable and/or highly sensitive information. Coordinates with the Quality and Risk Management Departments to obtain required QI Performance data.

Maintains the standard tracking log in order to stay on track, have details available to answer questions regarding status and to allow transparency of metrics.

Qualifications

REQUIRED:

High school diploma or equivalent

Minimum of one (1) year experience in the healthcare industry

Word, Excel and Access data base experience

Ability to type a minimum of 65 wpm

PREFERRED:

College level coursework and/or degree

Two years experience in field of credentialing

6 months -2 years verification experience

6 months -2 years Basic knowledge of medical coding and terminology

Certified Provider Credentialing Specialist- CPCS

Primary Location: California, Peninsula/South Bay and Santa Cruz, Mountain View

Organization: Palo Alto Medical Foundation

Employee Status: Regular

Benefits: Yes

Position Status: Non-Exempt

Union: No

Job Shift: Day

Shift Hours: 8 Hour Shift

Days of the Week Scheduled: Monday-Friday

Weekend Requirements: None

Schedule: Full Time

Hrs Per 2wk Pay Period: 80

All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state, or federal law, ordinance or regulation. External hires must pass a background check/drug screening. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state, and local laws, including but not limited to the San Francisco Fair Chance Ordinance.