• Location: Beverly Hills, CA
• Type: Contract
• Job #85272

APR Consulting, Inc. has been engaged to identify a Credentialing Specialist
 
Location: Beverly Hills, CA 90211
Position: Credentialing Specialist
Pay Rate: $35.50/hr
Duration: 13 weeks
Expected Shift:   40 hrs/week
8am to 5pm
 
JOB SUMMARY
***Hybrid/Remote from LA County***
Will need to pick up equipment in Beverly Hills.
 
Required:
* HSD/GED
* Flu vaccination (no declinations/no exemptions)
* Experience with physician insurance compliance/data integrity
* Proficiency (Expertise) with Excel
* Understand of HMO and Fee For Service business lines
 
Preferred:
* Bachelors Degree
* Experience with Epic Tapestry
 
Primary Duties and Responsibilities
• Reviews Provider Information Forms (PIFs) related to the MDN’s managed care business operations (provider networks, HMO referrals, claims, contracts)
• Maintains the MDN’s all downstream provider contract grids
• Responsible for communicating changes to downstream provider agreements to our current third party MSO
• Assists Manager in resolving discrepancies in provider contract records within EPIC’s Tapestry Module and associated HMO referral system(s);
• Maintains internal rosters to mitigate inadvertent leakage resulting from incorrect listings
• Provides paneling information provided to Health Plans is accurate and timely to support Senate bill AB137
• Conducts routine audits of provider updates
• Assists with the implementation of new or amended ancillary and provider contracts.
• Works with Contracting team to determine financial implication of identified discrepancies
• Periodically audit payor reports and provider listings to ensure accurate and complete participation of MNS-represented physician networks.
 
 
 
Our client is the one of the largest Healthcare Staffing Provider in the United States, to be assigned at one of their affiliated hospitals/healthcare facilities.
 
 
This particular client is requiring that all new hires show proof of vaccination. However, accommodations may be made for those with disabilities or religious reasons who cannot obtain a vaccine.
 
Since 1980 APR Consulting, Inc. has provided professional recruiting and contingent workforce solutions to a diverse mix of clients, industries, and skill sets nationwide.
 
We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law. Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.
 
Don't miss out on this amazing opportunity! If you feel your experience is a match for this position please apply today and join our team. We look forward to working with you!