Job Description
Description We are looking for a dedicated Credentialing Specialist to join our team in Palm Springs, California. This long-term contract position is ideal for someone with a strong attention to detail and a solid background in healthcare credentialing and compliance. The role involves ensuring providers meet managed care requirements and adhere to California-specific regulations.
Responsibilities:
- Manage the initial credentialing and recredentialing processes for healthcare providers, ensuring compliance with relevant standards and guidelines.
- Verify provider qualifications, including licenses, certifications, education, and work history, in line with California state regulations.
- Maintain a thorough understanding of managed care policies and contracts to ensure proper credentialing procedures.
- Ensure adherence to standards set by regulatory organizations such as the National Committee for Quality Assurance (NCQA), The Joint Commission, and Centers for Medicare & Medicaid Services.
- Maintain accurate and up-to-date credentialing records, performing regular audits to ensure data integrity.
- Act as the primary point of contact for providers, managed care organizations, and regulatory agencies, resolving inquiries and providing guidance on credentialing requirements.
- Oversee the renewal process for provider contracts and credentials, addressing any appeals or disputes as needed.
- Identify opportunities to streamline credentialing workflows and implement improvements in line with regulatory updates.
- Monitor compliance with California-specific licensing and managed care guidelines, ensuring readiness for audits.
- Stay informed about changes in healthcare regulations and adjust credentialing processes accordingly. Requirements - Associate's or Bachelor's degree in healthcare administration, business, or a related field, or equivalent experience.
- At least 2-3 years of experience in credentialing, preferably within a managed care or healthcare organization.
- Proficiency with electronic health record (EHR) systems and credentialing software.
- Strong understanding of California-specific healthcare credentialing laws and managed care requirements.
- Familiarity with standards from NCQA, The Joint Commission, and other regulatory bodies.
- Excellent organizational skills and attention to detail.
- Strong communication abilities, both verbal and written, with the capability to manage multiple priorities.
- Certification as a Certified Provider Credentialing Specialist (CPCS) is highly preferred. TalentMatch®
Robert Half is the world's first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.
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All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.
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Job Tags
Permanent employment, Contract work, Temporary work,
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