People are the most important asset of Imperial, for this reason the difference and plurality of people, equality of opportunities, non-discrimination and inclusion in the workplace are priority and strategic factors in the Organization. Imperial maintains a strong will to promote Diversity, Equity, and Inclusion, through inclusive leadership as a lever change and business sustainability.

Imperial Health Plan of California, Inc. is approved by California Department of Managed Health Care to offer full-service Medicare Advantage coverage, including a Medicare Advantage Prescription Drug plan, and a Chronic Condition Special needs plan over numerous counties in California. Through its affiliate, Imperial Insurance Companies, Imperial also offers Medicare Advantage plans in Texas, New Mexico, Utah, and Arizona.

Mission is to deliver valuable care so that members are healthy in body, mind, and spirit to achieve their inherent potential.

Vision is to deliver value based care that is clinically effective, sustainable, and achieves exceptional outcome. Please be sure to check our company website at https://imperialhealthholdings.com

JOB SUMMARY: Responsible for processing high volume of initial provider applications, including Allied Health Professionals in accordance with departmental policies and procedures, CMS and NCQA standards. Ensures interpretation and compliance with the appropriate credentialing regulations. Responsible for the accuracy and integrity of the CAQH and credentialing tracking databases. Acts as the liaison between the credentialing services and providers/health plans.

ESSENTIAL JOB FUNCTIONS:

1. Completes all applications using primary source verifications.

2. Identify any adverse actions from provider and document for review.

3. Review completed applications for submission to Credentialing Committee for approval.

4. Ensures that all provider files are complete with current licensing and certification documents.

5. When appropriate, works cooperatively with administrative staff to obtain pertinent information necessary for IPA's.

6. Possess thorough understanding of credentialing terminology and documents and is able to utilize external systems used to research and obtain pertinent information.

7. Manages provider profiles in practice management system.

8. Manages IPA coordination for information, and ensures providers are maximized.

9. Responsible for the timely gathering and submitting for processing to IPA’s and health plans on an ongoing basis, all credentialing and re-appointment applications.

10. Assist provider on completing credentialing application when necessary.

11. Tracks all pending applications and notifies the Manager of any challenges with obtaining provider information.

12. Responsible for reviewing and verifying all credentialing documentation for providers, confirming consistency and accuracy based on regulatory requirements.

13. Coordinates review and approval of clean files by the Medical Director.

14. Prepares credentialing documentation for the Risk Management and Compliance Committee.

15. Prepares credentialing documents for approval from the Medical Director and Credentialing Committee.

EDUCATION/EXPERIENCE:

· High school graduate or equivalent.

· 5+ years credentialing experience in a hospital, medical staff office or health plan. Strong CAQH and ICE Checklist experience required. Primary Source Verification experience a plus.

SKILLS/KNOWLEDGE/ABILITY:

· Proficient in the use of Microsoft Office: Word, and Excel

· Proficient in the use of Adobe Acrobat

LICENSURE/CERTIFICATE/TRAINING:

· CPCS or CMSC Certificate is a plus

Job Type: Full-time

Pay: $30.00 - $34.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Ability to commute/relocate:

• Pasadena, CA 91106: Reliably commute or planning to relocate before starting work (Required)

Experience:

• Microsoft Office: 3 years (Required)
• Microsoft Excel: 3 years (Required)
• credentialing: 5 years (Required)

Work Location: In person

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