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Credentialing Specialist

Job ID 110426 Date Posted 06/10/2021
San Diego, California
  • Sharp HealthPlan
  • Health Services
  • Day Job
  • Full-Time
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Responsibilities

Summary

The Credentialing Specialist performs and coordinates essential credentialing functions in an effort to attain and maintain quality practitioners in the provider network. Develops credentialing policies and procedures per NCQA standards and other regulatory requirements. Serves as a liaison to delegated entities and vendors to ensure current and adequate credentialing process are in place. Develops and performs queries for data reporting purposes to include directories, hoc reports, and network management reports. Responsible for the maintenance of the provider database and is responsible for providing provider related reports to internal and external entities.

If you like the sound of what it means to be a Sharp Health Plan team member, and you meet the qualifications above, please submit your resume along with a brief explanation about why you would be a good fit for this position. We look forward to hearing from you!  

Sharp Health Plan is the largest, locally-based commercial health plan in San Diego. We are a not-for-profit organization serving the needs of San Diegans since 1992. As a subsidiary of Sharp HealthCare, San Diego’s largest provider of health care services, we not only serve the people of San Diego, we are the people of San Diego.

Through our unique integration with Sharp HealthCare, we connect our members to an award-winning network of hospitals, medical groups and physicians. We offer health insurance options for individuals, families, groups and businesses that combine affordability, choice, high-quality health care and personal service.

Location

This position is located in Kearny Mesa, San Diego County

 

Hours

8-hour Day shift

 

Required Skills and Qualifications

 

  • Bachelor's degree in Healthcare Management, Business, or other degree acceptable with a combination of education, managed care,and supervisorial experience

  • Requires a minimum of 3 years in the managed care field and 2 year database management

  • Excellent written and verbal communication skills

  • Excellent organization and interpersonal skills

  • Ability to effectively supervise staff activities

  • Ability to exercise mature and sound judgement

  • Thorough understanding of managed care principle, evolutions, and models

  • Familiarity with DMHC and DHS audit requirements as well as NCQA standards for delegation

  • Demonstrates courteous, professional, and cooperative behavior toward internal and external customers

     

     

    Preferred Skills and Qualifications

     

  • CACTUS credentialing application  experience
 

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability.

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