Credentialing Specialist

Credentialing Specialist (Sepulveda - Health & Innovation)

This is a hybrid position based in Culver City, CA. Candidates must be local to Southern California with the ability to travel to our locations as needed.

The pay range for this position is between $23.41-$26.93 per hour. You will have the option to elect into a 9/80 flex work schedule after three months of employment.

Ask us about loan repayment programs you may qualify for by working at Didi Hirsch.

Didi Hirsch Mental Health Services has been a national leader in whole-person mental health, crisis care, and substance use services since 1942 and is home to the nation's first Suicide Prevention Center. We are a nonprofit organization providing care to about 270,000 people annually across our programs. Didi Hirsch has deep roots in community-based mental health and a commitment to providing culturally responsive services that are just and equitable. More than 1,000 dedicated employees and volunteers make Didi Hirsch's work possible.

Summary

As a Credentialing Specialist, you will be responsible for performing credentialing, re-credentialing and related activities according to Didi Hirsch, Medi-Cal Managed Care plan, commercial insurance, department of mental health (DMH), Department of Health Care Services (DHCS), Centers for Medicare and Medicaid Services (CMS), and relevant accrediting agency guidelines.

Primary Duties

Provider level credentialing, recredentialing and user profile management:

• Responsible for completing all provider level credentialing, recredentialing and certification activities with all Medi-Cal Managed Care Plans, Medicare and commercial insurance plans.
• Completes all credentialing and enrollment applications for staff.
• Submits required documentation including but not limited to staff rosters and compliance attestations on a regular basis to payers.
• Responsible for managing all aspects of staff credentialing, recredentialing, and ongoing staff information management for:
  
  
  
  • Department of Mental Health (DMH)
  • Substance Abuse Prevention and Control (SAPC)
  • Managed care plans
  • Contractors and other payers
  
  
  
  
• Ensure accurate and timely updates across the following platforms:
  
  
  
  • Network Adequacy Provider Portal Application (NAPPA)
  • National Plan and Provider Enumeration System (NPPES)
  • Network Adequacy Certification Tool (NACT)
  • RxNT (electronic prescribing system)
  • Council for Affordable Quality Healthcare (CAQH) portal
  • Provider Application and Validation for Enrollment (PAVE)
  • EXYM (electronic health record system; includes new hire setup, terminations, leaves of absence)
  • Substance Abuse Prevention and Control (SAPC) staff profile setup and management
  • SAGE
  • Substance Use Disorder Bed Availability Tool (SBAT), including daily updates to ensure compliance
  
  
  
  
• Monitors provider onboarding tasks and collaborates with electronic health records (E.H.R.) team to ensure proper set up in the E.H.R.
  
  
  
  • Tasks include but not limited to ensuring compliance with credentials, training requirements, taxonomies, SNOMED.
  
  
  
  
• Assists with obtaining waivers for staff and tracks all relevant regulations.

Agency-level credentialing, recredentialing:

• Assists agency level credentialing/certification activities including but not limited to Medi-Cal certification.
• Supports external audits and agency credentialing/certification.
• Facilitate any requests from Managed Care Plans (MCPs).

Compliance activities:

• Responsible for tracking all training requirements by government contracts, commercial insurance, Medi-cal managed care plans and all other payers.
• Collaborates with the Training Division to ensure compliance with training requirements.
• Participates in internal and external audits related to credentialing and compliance.
• Collaborates with internal and external stakeholders on responding to sanction reports and notifications.
• Conducts audits and resolves credentialing related issues resulting in claims denials.
• Maintains current and up to date credentialing files in accordance with agency policies and applicable regulations.
• Ensure credentialing processes meet standards set by regulatory agencies, such as the Joint Commission.
• Ensure required documentation (i.e. TB Test, Registration/Certification/License, Acknowledgement forms, etc.) is provided to Human Resources and Training Division for all new SAPC providers.
• Provide Help Desk Coverage for the E.H.R. team when needed.
• Provides support on compliance related activities and projects as needed.
• Other duties as assigned.

Position Requirements

• Associate's Degree required; Bachelor's Degree preferred.
• Minimum 2 years of credentialing/compliance experience in a healthcare setting is required.
• Experience with provider enrollment with PAVE, CAQH, Medi-care and commercial payors is required.
• Meticulous attention to details to ensure accuracy and completeness of agency records.
• Strong organizational skills and ability to juggle multiple deadlines.
• Very clear oral and written communication skills required.
• Strong customer-service oriented interpersonal skills required.
• Strong analytical and critical thinking skills required.
• Commitment to continuous learning and process improvement preferred.