Offer summary

Qualifications:

Five years of experience in credentialing or contracting in a hospital or IPA setting., High school diploma or GED required; Bachelor's in Business Administration preferred., Training in provider information management is advantageous., Strong attention to detail and quality assurance skills are essential..

Key responsibilities:

Process provider change forms accurately and in a timely manner.

Maintain provider listings and follow up with health plans on submissions.

Conduct audits of new employee work before submission to health plans.

Educate staff on updates and improvements related to health plans.

With approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Texas and Rhode Island. In the months and years ahead, we will be offering our services in other states and other markets throughout the nation. Our extensive care services range from primary care and specialty physician services to acute care hospital and skilled nursing facilities to behavioral health and wellness services. Each of our Independent Physician Associations (IPAs) and networks support the use of advanced diagnostic and treatment tools to provide our members with convenient access to state-of-the-art healthcare. Our pledge to members is that we will give you exceptional care delivered by compassionate physicians who have a strong commitment to each and every patient. Our physicians work closely with teams of skilled nurses and other healthcare professionals. Prospect Medical contracts with most major health plans, and we serve all product lines, including Commercial, Medicare, Medicaid, Medicare/Medicaid (Medi-Medi) and Health Insurance Exchange. To further improve the health of the communities we serve, Prospect Medical offers comprehensive health education classes and support services through our numerous outreach programs. Diversity and Inclusion Within Our Workforce At Prospect Medical, we believe that a diverse and inclusive environment enriches our workforce and the communities we serve. To that end, we embrace the diversity of our coworkers, physicians, vendors and patients. We do not tolerate harassment or discrimination on the basis of race, ethnicity, religion, gender, sexual orientation, gender identity or expression, national origin, age, disability, veteran status or any other characteristics protected by law. We embrace diversity because it is our culture, and it is the right thing to do.

Job description

Job Description

The Provider Information Coordinator is responsible for submission of data provided to the health plan, quality assurance of rosters and identifying trends. In addition to assisting in educating the staff on improvements and updates of health plans.

Responsibilities

Responsible for timely and accurate processing of provider change forms.| Responsible for the submissions to contracted health plans for applicable network.| Responsible for provider listing maintenance and follow-up with health plans to ensure that all submissions have been processed appropriately.| Audit new employees work prior to submission to health plans within thirty (30) days of training.|Review Change Form on CDA, Morrisey reports, emails submitted to health plans. Review PID retrieval and resubmission process. Quality review of rosters submitted to health plans.| Assists in educating and updating the PIM/Credentialing Department on new guidelines.| Resource for training, education and coordination of improvements and additions. Weekly review of reports to identify areas for training.| Identify trends and report to management.

Qualifications

Five (5) years' experience and/or training in credentialing and/or contracting in a hospital or IPA setting. High school diploma or GEDBachelors in Business Administration or equivalent from a four year college or technical school preferred.

Required profile