Job Details

Who we are: La Clinica de La Raza is a non-profit, community-based health center established in 1971 to address health barriers and create better lives for the underserved. We have proudly grown into over 35 sites across Alameda, Contra Costa, and Solano County. To learn more aboutour history, click here: Our History - La Clinica or visit our website at www.laclinica.org.

Job Summary:

Under the direction of the Provider Enrollment and Contracts Supervisor, maintain clinical provider credentialing files, coordinate credentialing and re-credentialing application process of clinical providers (medical, dental, optometry and behavioral health) and clinics with participating health insurance plans.

Major Areas of Responsibility, include but are not limited to:

Duties/Responsibilities:

Health Plan Contracts:

• Develop and maintain provider credentialing files and internal electronic tracking systems.
• Review clinical provider applications for completion and accuracy, ensure timely and accurate follow-up, monitor and report on the credentialing progress of each practitioner.
• Maintain timely and accurate data entry, and periodically revise provider data in the department records; maintain provider demographic and electronic data files; use Council for Affordable Quality Healthcare (CAQH) system to submit provider data as required by health plans.
• Utilize extensive Internet and telephone communication to obtain and share information.
• Notify insurances carrier and other relevant entities of provider changes.
• Update health plan directories with accurate information about participating clinics and providers.
• Act as liaison between providers and contracted insurance plans in the areas of credentialing, provider relations and orientations.
• General administrative tasks as needed.

Credentialing & Privileging:

• Assist with all duties related to credentialing and privileging (C&P) aligned with La Clinica C&P policy
• Utilize CredentialStream to maintain current and accurate record of C&P clinical staff data, including initial and re-credentialing
• Maintain and monitor credentialing files with all required supporting documentation
• Coordinate the credentialing process, as outlined in the agency's policy, for all new Licensed Independent Practitioners (LIPs), Other Licensed or Certified Practitioners (OLCPs), Other Clinical Staff (OCS), volunteers, locums, and independent contractors.
• Collaborate with the HR recruiters to monitor recruitment status of candidates to ensure timely credentialing prior to employment
• Communicate with clinic managers to ensure the re-credentialing requirements are met and maintained
• Maintain and closely monitor clinical license, certification, and/or required regulatory registration (DEA, BLS, etc.) for all clinical staff to ensure C&P requirements are current at all times.
• Manage the electronic tracking systems to capture and report on all credentialing requirements

Minimum Job Requirements:

Knowledge, Skills, and Abilities:

• Demonstrated ability and commitment to excellent customer service to maintain and ensure effective working relationships with internal and external clients.
• Excellent attention to detail and high degree of accuracy, in fast-paced environment.
• High level of organizational skills and demonstrated ability to maintain and improve systems.
• Ability to maintain confidentiality.
• Demonstrated ability to perform tasks involving independent judgment.
• Ability to manage multiple projects efficiently and accurately, prioritizing and managing deadlines.
• Proficient in Microsoft Office (Word, Outlook, Excel) and office machines
• Able to maintain a steady pace, at times working at a fast pace to meet deadlines or when working under short notice.

Education and Experience:

• High School diploma.
• 1-2 Years work experience in all facets of credentialing, including interacting with physicians and other health care providers.
• Experience in working with various databases
• Experience with medical and professional credentialing processes, policies and procedures, including credentialing requirements
• Experience with practitioner credentialing, data collection and record management systems
• Experience in a community health care setting, preferably with insurance or managed care plans experience

Physical Requirements:

• Remaining in a stationary position, often standing, or sitting for prolonged periods
• Bending/lifting, pushing/pulling, adjusting, or moving objects weighing up to 15 pounds in all directions and occasionally more.
• Repeating motions that may include the neck, wrists, hands and/or fingers.
• Upper extremity demands: Reaching above shoulder and/or below waist.