Job Description
WORK LOCATION: United States-California- Fountain Valley
SCHEDULE: Full-time
JOB TYPE: Cal Optima Biller/ Credentialing
We are an established behavioral health center working with the County of Orange. If you have experience, knowledge and established relationships then you are whom we are looking for. Experience working with Cal Optima and clinical notes is a bonus.
DESCRIPTION
**IN ORDER TO BE CONSIDERED, APPLICANTS MUST HAVE MEDICAL STAFF AND/OR MANAGED COMPLIANCE EXPERIENCE, FAMILIARITY WITH JOINT COMMISSION AND QUALITY ASSURANCE, AND REGULATORY REGULATIONS.
SUMMARY: Responsible for compliance and HR on-boarding our established behavioral health center with in-network insurance providers, and maintenance of information to include primary source verification, follow up, data collection, data entry, and document review. Excellent communication and relationship building skills, behavioral health or hospital compliance experience is required, along with compliance with Joint-Commission policy and procedure, State regulatory and accrediting agencies. Experience in credentialing toxicology laboratories and non-profits desired.
DUTIES INCLUDE BUT ARE NOT LIMITED TO:
Maintain high quality, timely and accurate credentialing processes of medical and mental healthcare professionals per policy and procedure
Assist in the compliance process by entering/logging/scanning information into credentialing system for initial, updated, add on applications and maintenance processes
Acts as liaison with and as point person for completing and ensuring compliance and delivery of required information to insurance companies in a timely manner
Process and maintain compliance in accordance with policy and procedure, Joint Commission standards, State and Federal Regulatory regulations. This will include but is not limited to the following verification:
Drug Medical/Cal Optima
DEA Verification
Licensure
Board Certification
Residency/ Fellowship
Training Verified
Peer Recommendation
Professional Schooling Verified
Ensure that all credentials files are current and complete pursuant to expiration date of medical licenses, board certification, professional-liability insurance coverage, DEA and other pertinent information, per policy and procedure
Monitor collection of all information received; follow up on missing items and/or incomplete forms per policy and procedure, submit follow up requests for verification as needed
Identifies and evaluates potential red flags and works in collaboration with provider to document the issue and response
Advise Manager and/or Director of questionable information received and any issues identified during the processes
Submit closed files for audit/final review and secure missing items as identified by audit/final review
Maintain all credentials files ensuring that all correspondence in the credentialing and reappointment process is accurately filed; is knowledgeable and current on the process and legal/regulatory requirements
Compliance with policy and procedure, Federal and State regulatory and accrediting agencies as required
Perform other duties and works on special projects as requested
QUALIFICATIONS
EXPERIENCE
Minimum one-year experience preferred in behavioral health healthcare compliance (i.e., healthcare facility, managed care setting, credentials verification organization, or Medical Staff Office) and Human Administration
Experience with Credentialing Accreditation by Joint Commission or National Committee for Quality Assurance preferred
Demonstrated working knowledge of the health care and credentialing industry, including medical-legal issues and laws, regulatory agencies, and other national standards preferred
Completion of training testing of 90% or greater
Understanding of professional telephone etiquette
Ability to work with minimal supervision and works well in both individual and group environment
EDUCATION
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Company Description
www.stephouserecovery.com Compensation in commensurate with experience......