Job Description
Posting Details About WesternU
As you take your first step onto a Western University of Health Sciences campus, each path, each person, each structure comes with a transformative story. WesternU is more than the practice of medicine. We are defined by character and culture.
At WesternU, you will discover humanism at the heart of every interaction: a warm welcome, a sincere smile, a positive word, a kind deed, a thoughtful gesture. You will see students work together on case studies; a parade of pets in campus parks; student clubs offering opportunities for career growth and community involvement; and faculty, staff and students designing their future and the future of WesternU. We display a collaborative mindset in how we operate, educate, and serve others.
Although, geographically, we are two campuses - as humanists, we are one: to enhance and extend the quality of life in our communities and achieve excellence in everything we do. We attract diverse, professional faculty, staff and students that thrive in an environment of humanistic health care education. Join our team of faculty and staff and make a difference.
Posting Details
Position Title Credentialing Specialist
Position Control Number 100455
Type of Position Staff
Position Status Full-time
Campus Western University Campus-Pomona, CA
Position Location California
Department 1313-Patient Care Center - PCC
Job Summary Provides integral support to healthcare operations by enabling timely onboarding of healthcare providers through the evaluation, analysis, and coordination all aspects of the credentialing and recredentialing processes for practitioners practicing within the WesternU Health System clinical entities.
Knowledge, Skills and Abilities Individuals must possess the knowledge, as well as the following skills and abilities or be able to perform the essential functions of the job, with or without reasonable accommodation using some other combination of skills and abilities.
- Strong working knowledge of healthcare provider credentialing process
- Experience working with Windows based applications: Excel, Word, Outlook, SharePoint
- Significant knowledge of State and Federal Regulatory requirements and accreditation standards, e.g., NCQA, NPDB, Title XXII, CAQH and NPPES related to healthcare provider credentialing
- Considerable working knowledge of credentialing management applications, e.g., Verity Stream
- Strong customer focus, interpersonal, collaboration, written/verbal communication, prioritization, and computer skills
- Must be able to establish daily work priorities and work efficiently to contribute to the successful overall maintenance of the credentialing process.
- Demonstrated attention to detail and good organizational capability.
- Able to handle multiple simultaneous tasks and complete work projects in designed time frames.
- Demonstrate a commitment to working in an organization that values and promotes humanism.
Required Qualifications Any combination of education, training and experience that provides the required knowledge, skills, and abilities.
- Education: High School Diploma or equivalent.
- Experience: Minimum of two years of relevant experience in provider credentialing.
Preferred Qualifications Preference will be given to individuals with NAMSS Certification as Certified Provider Credentialing Specialist (CPCS) certification.
- Experience: A background in clinical academic setting is highly preferred.
Essential Job Duties
Key Responsibilities - Reviews and screens initial and reappointment credentialing applications for completeness, accuracy, and compliance with federal, state, local and University regulations, guidelines, policies, and standards.
Key Responsibilities - Prepares documents for primary source verification process, collects, and validates documents to ensure accuracy of all credentialing elements.
- Assesses completeness of information and qualifications relative to credentialing standards and WesternU Health System criteria.
Key Responsibilities - Identifies, analyzes, and resolves extraordinary information, discrepancies, time gaps and other peculiarities that could adversely impact ability to credential and enroll practitioners.
- Discovers and conveys problems to Executive Director University Compliance and Chair of Provider Credentialing Committee for sound decision making in accordance with credentialing policies and procedures, federal, state, local and government/insurance agency regulations.
Key Responsibilities - Monitors files to ensure completeness and accuracy; reviews all file documentation for compliance with quality standards, accreditation requirements, and all other relevant policies.
- Prepares and provides information to internal and external customers as appropriate.
Key Responsibilities - Enters, updates, and maintains data from provider applications into credentialing database, focusing on accuracy, and interpreting or adapting data to conform to defined data field uses, and in accordance with internal policies and procedures.
Key Responsibilities - Submits and responds to requests for required documentation to third-party payors for credentialing/recredentialing.
Key Responsibilities - Prepares, issues, electronically tracks and follows-up on appropriate verifications for efficient, high-volume processing of individual applications in accordance with applicable credentialing standards, established procedural guidelines, and strict timelines.
Key Responsibilities - Participates in the development and implementation of process improvements for the system-wide credentialing process,
- Prepares reports and scoring required by regulatory and accrediting agencies, policies, and standards.
Key Responsibilities - Communicates clearly with providers, their liaisons, Clinical Deans and WesternU Health Administration, as needed to provide timely responses upon request on day-to-day credentialing and privileging issues as they arise.
Key Responsibilities - Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest developments to enhance understanding of various regulations and legislation of the health care industry.
Key Responsibilities - Performs miscellaneous job-related duties as assigned.
Posting Details Continued
Work Schedule - Monday-Friday, 8 AM -5 PM.
Working at WesternU
We believe in making an impact in the lives of our employees, personally, and professionally. Every employee has different individual and/or family needs. We offer benefits that are both comprehensive and flexible to address your unique needs. We believe work-life harmony is positive and achievable.
We offer competitive salaries, generous paid time off, insurance plans, reimbursements, and retirement benefits. Additionally,
• Our faculty, staff, and administrators are 100% focused on student success.
• Our University culture creates the context for a nurturing and supportive environment.
• Faculty, staff, and students can expect to make deep, personal relationships within the University community.
• As a Faculty, Staff, or Student at WesternU, you can focus on work that you love, be your authentic self, and lead to the future with innovation in health sciences.
• WesternU's core value of humanism encourages all to bring their whole self in all that they do.
• We are committed to fostering a culture of respect, equity, collaboration, and fun at all levels for all people!
Expected Pay Scale
Minimum $25.00 Hourly
Maximum $28.00 Hourly
Job Tags
Hourly pay, Full time, Local area, Monday to Friday, Flexible hours,