Enrollment & Credentialing Specialist

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

The Enrollment and Credentialing Specialist is responsible for completing initial credentialing and re-credentialing.

The Specialist will ensure that all providers are in active status while employed with Planned Parenthood Orange and San Bernardino Counties (PPOSBC).

This includes ensuring all providers are credentialed and re-credentialed in compliance with Medicaid, IPA, Health Plans, and other medical regulatory agencies.

The Specialist will also manage platforms such as CAQH and PAVE.

In addition to credentialing duties, the Specialist will guide PPOSBC patients through the insurance change process to enroll in Melody Health.

The Specialist is responsible for generating monthly and monitoring the PCP Switch Payroll incentive report. 

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.


* Process and complete initial credentialing and re-credentialing for providers.


* Manage and update credentialing information in CAQH.


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

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


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


* Assist providers with their Medi-Cal enrollment applications through the PAVE portal, ensuring accurate submissions.


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

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


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


* Serve as the point of contact for providers regarding credentialing, enrollment, and PAVE processes, ensuring c...