Credentialing Coordinator
CalOptima
- Ensures that the required timely documentation is appropriate and complete for verification processing of behavioral health practitioners, providers, mid-levels, allied health professionals, and other healthcare delivery organizations for the credentialing and re-credentialing process
- Processes all credential applications, initiates re-credentialing, and/or applications in established electronic file folders
- Initiates primary source verifications and other follow-up as required into the applicant's background, education, and experience using online systems, written correspondence, telephone inquiries, and printed reference guides and reports
- Partners with all necessary staff to ensure an integrated, timely, consistent product
- Collaborates with Provider Relations and Contracting departments on the status of candidates to ensure timely credentialing
- Prepares reports as requested
- Monitors and maintains reports published by Medical Board of California (MBOC), Centers for Medicare and Medicaid Services (CMS), Department of Healthcare Services (DHCS), Office of Inspector General (OIG), National Practitioner Data Bank (NPDB), and other applicable sources to identify adverse findings
- Implements an efficient and effective system for the transmission of credential information to internal and external sources to facilitate timely approval to participate as a CalOptima approved practitioner, provider, or HDO
- Stays current with changes and updates to laws and regulatory requirements
- Writes and implements desktop policies and procedures, as necessary, to remain in compliance
- Documents the monitoring of adverse license actions and legal actions
- Prepares non-compliance letters and alerts for all providers, when required.
