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Credentialing Specialist

Company: Innovative Management Systems Incorporated
Location: Hacienda Heights
Posted on: January 10, 2022

Job Description:

Our team at IMS is looking for highly motivated and resourceful individuals to join our growing start-up. We strive to innovate the healthcare industry by providing management and consulting services to healthcare entities, including healthcare facilities, medical groups, providers, and suppliers. Using our wide-ranging experience and comprehensive knowledge of the healthcare industry, our team works to provide quality services and customer care to our clients and their Medicare beneficiaries. By working at IMS, you'll gain an in-depth perspective of the managed care industry and share in the professional development of our expanding company. Take initiative and ownership of your projects to make a difference and go the extra mile! We welcome you to apply to join our team!

Position: Credentialing Specialist

This position report to the Director of Provider Services and is responsible for full cycle credentialing and provider enrollment with the business. Accurate practitioner database is maintained and ensures that compliance with regulatory and accrediting bodies and participates in the development and implementation of credentialing and enrollment policies and procedures. It is also expected that this position assist in other job duties, such as attending meetings, answering/troubleshooting phone calls, and other clerical/administrative work as is applicable to the department and/or position. Travelling to other providers' offices may be needed for credentialing reasons but will be notified in advanced.

Some Major Duties Include:

- Implements the credentialing and provider enrollment processes for identified healthcare providers.

- Performs primary source verifications as needed and monitors expiration of credentials and privileges.

- Reviews initial paperwork and applications to identify possible issues and follows up with the healthcare provider as needed to obtain any missing or additional information.

- Maintains the credentialing database to ensure required demographics and information is entered and stored correctly.

- Manages credentialing and enrollment timelines and communicates with necessary stakeholders as to status and barriers.

- Responds to internal and external inquiries on application and enrollment matters.

- Establishes and maintains positive and close working relationships with internal and external stakeholders.

- Participates in staff meetings and continuing education, and recommends new approaches, policies, and procedures to effect continual improvement in efficiency of the department and services performed.

- Assist with hospital privileging and/or reappointment applications.

- Performs internal audits internally and externally when needed regarding credentialing/re-credentialing process.

- Travelling to providers' offices may be required for credentialing purposes.

- Troubleshooting and making phone calls that pertain to Credentialing and/or Provider Service Department.

- Other duties and projects assigned.


Full Time, Benefits Eligible



$19 - $26.44, or Competitive Compensation

IMS offers competitive compensation. We are an equal opportunity employer and seek diversity in our workforce


Associate degree or equivalent experience.


Active and Valid Driver's License (unexpired) and unexpired car insurance.

Certified Provider Credentialing Specialist certification (CPCS) by National Committee for Quality Assurance (NCQA), preferred.


4+ years in a health plan or managed service organization


Strong communication skills.

Knowledge in credentialing and re-credentialing process.

Ability to interact with physicians, contractors, and all levels of management.

Always maintain strictest confidentiality

knowledge of federal and state laws and compliance regulations, such as HIPAA

*Documentation of fully vaccinated status against CoVid, as defined by the CDC, must be submitted no later than first day of work.


Keywords: Innovative Management Systems Incorporated, Hacienda Heights , Credentialing Specialist, Other , Hacienda Heights, California

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