Enrollment & Credentialing Specialist- Temp

Planned Parenthood of Orange and San Bernardino Counties has a full-time opportunity for an Enrollment & Credentialing Specialist-Temp in Anaheim, CA.

The Specialist will complete initial credentialing, maintain credentialing packets and work with external credentialing consultants to ensure all providers are in active status while employed with PPOSBC.

Specialist will ensure all providers are credentialed as required by Medicaid, IPA, Health Plan, ARMS and other medical regulatory agencies.

Other responsibilities will include guiding PPOSBC patients through the insurance change process to enroll in Melody Health.

The Specialist will assist with membership reporting and enrollment marketing campaigns to increase Melody Health patient base.

The Specialist is responsible for monthly monitory of Melody Health Enrollment numbers within PPOSBC’s gender and age bands.

Scope includes in-reach/outreach and collaboration with internal departments to maximize enrollment efforts in Melody Health.

The Specialist is responsible for generating the PCP Switch Payroll incentive report for each pay period.

At PPOSBC, we understand the importance of a well-rounded benefits program and are dedicated to providing you with unique benefits that meet the needs of you and your family.

We are proud to offer a range of plans that help protect you in the case of illness or injury including:


* A competitive benefits package including medical, dental, and vision coverage for you and eligible dependents, life insurance, and long term disability. 


* Benefits coverage starts after one full month of employment!


* Generous vacation, sick, and holiday benefits!


* Generous 401(k) matching contributions and more!


* To view our detailed benefits guide, please visit our career site at www.pposbccareers.org

Responsibilities

Essential Functions: Essential functions encompass the required tasks, duties and responsibilities performed as part of the job and the reason the job exists.


* Maintains the timelines on enrollment/credentialing schedules, communicates with providers and health plans to update as needed and maintain a strict level of confidentiality for all matters pertaining to provider credentials processing.


* Obtains credentialing data needed for onboarding, contracting, and other related purposes.

Credentialing data includes but is not limited to the medical degree, Drug Enforcement Administration (DEA) number, CDS, state licenses, Board certifications, CV, malpractice insurance etc.


* Monitor and track submissions and status changes with payers and update internal records.


* Educate patients on the importance of health care coverage and answer questions pertaining to the health care system as it relates to enrollment.


* Assist with patient retention efforts and reporting.


* Educate patients on primary care services offered at Melody Health.


* Assist and partner in community outreach activities in collabora...