Title: Credentialing Coordinator

Location: Fountain Valley, CA

Department: IPA - Provider Network

Status: Full-Time

Shift: Days (8hr)

Pay Range*: $25.22/hr - $36.57/hr

MemorialCare is a nonprofit integrated health system that includes four leading hospitals, award-winning medical groups – consisting of over 200 sites of care, and more than 2,000 physicians throughout Orange and Los Angeles Counties. We are committed to increasing access to patient-centric, affordable, and high-quality healthcare; your personal contributions are integral to MemorialCare's recognition as a market leader and innovator in value-based and other care models.

Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration, and accountability. Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation, and teamwork.

Position Summary

The Credentialing Coordinator is responsible for gathering and verifying physician information, compiling required documents, researching necessary information and interacting with primary sources to verify information submitted by network providers on their application. The Credentialing Coordinator ensures interpretation and compliance with the appropriate credentialing regulations.The Credentialing Coordinator is also responsible for the accuracy and integrity of the credentialing database.

Essential Functions and Responsibilities of the Job

1. Responsible for the timely processing of credentialing and re-credentialing applications and tracking of pending credentialing information for network providers.

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

3. Coordinates review and approval of clean files by CMO/SMD.

4. Schedules, coordinates, and prepares for credentialing committee meetings including but not limited to: booking meeting rooms, sending out meeting requests, preparing documents, assembling binders, and reserving lunch.

5. Coordinates with various departments including Risk Management and Quality Improvement for report preparation for credentialing committee.

6. Responsible for committee finalization, including but not limited to: mailing and filing of approval letters/sheets, organizing minutes for the minute’s binder, and entering approval dates in the credentialing database.

7. Assists Director with managed care delegated credentialing audits on an as needed basis.

8. Maintains accuracy and integrity of the credentialing database.

9. Maintains network provider credentialing files and conducts internal file audits to ensure accuracy and efficiency throughout the credentialing process.

10. Responsible for monthly network provider licensing expirables, renewals, and updates.

11. Responsible for Ongoing Monitoring, semi-annual, and quarterly reports.

12. Responsible for credentialing and re-credentialing internal providers with hospitals, IPA’s, medical groups, and health plans on an ongoing basis.

13. Prepares and sends check requests and appropriate documentation for hospital privileging, licensing renewals, and credentialing verification fees and payments.

14. Works with internal and external customers on day-to-day credentialing and privileging issues and requests as they arise.

15. Perform any additional duties as requested by management within the scope of knowledge.

*Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for this role, including but not limited to, shift differentials, extra shift incentives, and bonus opportunities. Health and wellness is our passion at MemorialCare—that includes taking good care of employees and their dependents. We offer high quality health insurance plan options, so you can select the best choice for your family. And there’s more...Check out our MemorialCare Benefits for more information about our Benefits and Rewards.

Minimum Requirements

Qualifications/Work Experience:

• Minimum of two years provider credentialing experience and experience working with various healthcare industry regulatory agencies and requirements including but not limited to CMS, NCQA, DMHC, ICE, DHCS, preferred.

• Proficiency in Microsoft Office applications including Word, Power Point, Excel, and Outlook is a must.

Education/Licensure/Certification:

• High school graduate or equivalent. 

• Credentialing certification preferred.