Provider Enrollment Specialist - Tuolumne Me-Wuk Indian Health Center : Job Details

Job DetailsJob Location Administration - Sonora, CA Salary Range $23.65 - $35.48 Hourly DescriptionPOSITION SUMMARY: This role holds responsibility for ensuring all aspects of the enrolling (credentialing) process for our providers. This process must happen for all of our payors as an initial process and again as a re-credentialing process. Effective time management, persistence, and ability to utilize appropriate software, databases, and online systems is a must. PRIMARY RESPONSIBILITIES: (will include, but not be limited to) As part of an initial credentialing of a new provider the incumbent in this role will be required to collect all appropriate data such as NPI's, copies of licenses, Drug Enforcement Agency certificates, and malpractice insurance information complete required privileging packets for submission for final approval by the Health Board. On a consistent and ongoing basis this role must maintain accurate records ensuring tracking of license and certification expirations to enable timely renewals. Must maintain the CAQH for Provider Month Attestation and update current information. Will also process enrollment applications for both government/commercial health plan payors, and manage the ongoing participation requirements of the plans for all providers enrolled. This is a fast-paced role requiring interactions and collaborations with multiple entities both inside and outside the organization. Building and maintaining these relationships is key to timely actions for our enrollment activities. QualificationsMinimum Qualifications:Education and Experience:Pattern I: High school diploma or GED required, with three (3) + years of experience in a comparable role enrolling Providers. OrPattern II: An associate's degree or higher with the approved certifications of: Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) or willing to obtain. Preferred Qualifications: Knowledge of federal and state regulatory requirements and accreditation standards (i.e. Joint Commission, NCQA, DNV, and CMS). Understanding of medical terminology, including Medicare and Medicaid, and other commercial payers Experience working with Native American population in a healthcare setting 2+ years preferred. PHYSICAL REQUIREMENTS: This position requires walking, standing, and sitting for prolonged periods of time; climbing stairs, step-stools, etc.; stooping, kneeling, crouching, balancing, and reaching; pushing, pulling and lifting up to 30 pounds; raising objects overhead; manual dexterity for operation of computer and phones; hearing, talking, and good verbal and written communication skills; repetitive motions of the wrists, hands, and fingers; subject to outside environmental conditions of heat and cold; and walking on uneven ground. The position requires the ability to safely operate and drive a motor vehicle. INDIAN PREFERANCE: Preference in filling vacancies will be given to qualified Native American or Alaskan Native Applicants, in accordance with the Indian preference Act (Title 25, U.S. Code Section 472 and 473) and Public Law 93-638, provided the applicant has submitted appropriate verification of Indian preference for employment. In House postings include Tribal Voting Members. All positions require sensitivity to Indian traditions, customs, and socioeconomic needs, and ability at times to meet and deal effectively with numerous tribes and varied cultures, which requires tact, courtesy, discretion, resourcefulness, and good judgment in handling functions of a sensitive nature. *Employment is contingent on passing pre-employment TB test, background check and drug testing. Tuolumne Me-Wuk Indian Health Center is an Equal Opportunity Employer.