Job Description

The Credentialing Specialist plays a critical role in coordinating, monitoring, and managing all aspects of the credentialing, re-credentialing, and privileging processes for Tiburcio Vasquez Health Center’s medical, dental, behavioral health, and other healthcare providers. This on-call position ensures compliance with credentialing and privileging requirements by obtaining and verifying all necessary information, maintaining accurate provider files, and preparing relevant documentation for reporting purposes. Additionally, the Credentialing Specialist assists in monitoring and renewing various facility licenses to maintain operational compliance.

The Credentialing Specialist collaborates closely with the Human Resources Department (HR), hiring managers, and organizational leadership to ensure an efficient and seamless credentialing process, supporting the onboarding and continued compliance of all healthcare practitioners.

About Us:
Tiburcio Vasquez Health Center is a non-profit community health center that is dedicated to promoting the health and well-being of our community by providing accessible, high quality care by integrating primary care, dental care, WIC support, mental health counseling, community health education and more.

Compensation: $29.35 - $36.86 per hour, which includes a differential in pay in lieu of benefits.

TVHC offers compensation ranges that are determined by a thorough market-based analysis and are fully disclosed in accordance with California law. The pay for a selected candidate is determined by a variety of factors to ensure fair and equitable compensation. These factors include the candidate's experience, education, skills, training, licensure, certifications, and the specific scope of the role. We are committed to providing a competitive compensation package that extends beyond base salary, designed to support the health, wealth, and career development of our employees.

Responsibilities:

• Manages and monitors the credentialing applications throughout the credentialing process, adhering to critical path timelines and ensuring timely completion
• Identifies potential delays or variances from the credentialing plan, escalating issues to appropriate stakeholders for resolution.
• Completes, submits, and updates credentialing documentation with various health organizations, ensuring accuracy and compliance.
• Tracks and maintains internal privileging approvals, board certifications, DEA certifications, BLS certifications, and professional license expiration dates in the credentialing system. Proactively collects updated certifications and licenses ahead of expiration to maintain organizational and provider compliance.
• Coordinates the re-credentialing and privileging process for licensed and clinical staff on a two-year cycle, ensuring uninterrupted clinical privileges.
• Serves as one of the primary point of contacts for providers’ credentialing needs and concerns, collaborating with the Chief Medical Officer, Chief Integration Officer, and HR team to provide timely solutions.
• Ensures all compliance-related documentation is collected, reviewed, verified, and systematically updated in the credentialing system.
• Collaborates with the Director of Compliance and Risk Management to conduct internal credentialing audits, identifying and resolving potential issues that may arise during HRSA audits. Communicates audit results and recommendations to the Chief Medical Officer and HR.
• Assist with initial enrollment and re-enrollment of the clinic and providers into PECOS, Medi-Cal, and any other payers contracted by TVHC.
• Maintains and updates provider enrollment records to ensure all information remains current and compliant with health plan requirements.
• Other tasks or projects as assigned.

Requirements

• High school diploma required.
• Associate's or Bachelor's degree in healthcare administration, business administration, or a related field preferred.
• Minimum three (3) years of experience in credentialing and provider enrollment required.
• Experience with accreditation processes and standards.
• Database management skills including querying, reporting, and document generation.

Qualifications:

• Exceptional attention to detail and organizational skills.
• Strong communication and interpersonal abilities to collaborate effectively across teams.
• Proficiency in credentialing software, Microsoft Office Suite, and database management tools.
• Proven ability to prioritize tasks, manage multiple deadlines, and work efficiently in a fast-paced environment.
• In-depth knowledge of relevant regulations, standards, and payer requirements.
• Strong problem-solving skills with the ability to work both independently and as part of a team.

Job Tags

Hourly pay,

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