Credentialing Specialist

Why work for Balboa:

• Balboa Nephrology is the largest kidney care practice in California and participates in a national Medicare program focused on value-based care.
• Through our joint venture with Evergreen Nephrology we are a growing organization with opportunities for professional and personal growth.
• We will help you grow in your leadership experiences while learning the new value-based care world.
• Comprehensive benefits package that includes medical dental & vision on the 1st of the month 30 days after hire.
• Employer contribution of up to 10% of annual pay for your 401K.
• Generous paid time off plus 8 paid holidays a birthday float day off and a mental health day!
• Company paid life insurance.
• Join a fast-growing field - employment of medical and health services managers is projected to grow 32 percent from 2020 to 2030 much faster than the average for all occupations.
• Voted 4 years in a row as a Top Workplace of San Diego 2020-2024!
• Hybrid position after successful completion of onboarding/training.
• Eligible for a department bonus after 90 days of employment.

Our Values:Patient-centered I Accountability I Respect I Innovation I Data-Driven

Our Mission:to consistently deliver superior care Balboa Care to every patient with kidney disease.

Work location:Hybrid

• Will work out of our Executive Square office in La Jolla San Diego CA.
• Eligible for hybrid schedule upon successful completion of onboarding/training. Position is usually in office 1-2 days a week subject to business needs.

Position Summary:

The Credentialing Specialist works closely with the Credentialing Manager and key stakeholders and is responsible for all aspects of credentialing and re-credentialing as it relates to medical provider enrollment with payors facilities and government entities as assigned. This position ensures all medical providers are appropriately credentialed which includes the responsibility of maintaining current information on file and within the credentialing database. The Specialist is responsible for timely provider updates and directory accuracy with all health plans.

Pay Rate:$26.00/hour and up depending on experience.

Essential Duties and Responsibilities:

• Completion of Providers credentialing and re-credentialing applications.
• Maintenance of CAQH profiles and internal credentialing database and ensure up-to-date information is obtained at all times.
• Responsible for monitoring and managing credentialing/re-credentialing requirements and to ensure the collection of all required renewal certifications are on file within the required time frame.
• Provide consistent and timely follow-up on all outstanding credentialing/re-credentialing applications.
• Provide support to providers providers office staff Revenue Cycle staff health plan contacts and company departments as necessary.
• Timely updates to provider directory information on several platforms in compliance with CA Senate Bill 137.
• Supports and actively participates in process improvement initiatives.
• Assists with other duties to support the revenue cycle process and Balboas core values.

Required Qualifications:

• 2 years recent medical provider enrollment/credentialing experience in a medical group or physician setting.
• Strong proficiency with Microsoft Windows (ability to navigate create and rename folders save and organize files) Strong proficiency with Microsoft Office products (Outlook OneNote Teams Excel Word) proficiency with Adobe PDF. Ability to type 30 words per minute.

Preferred Qualifications:

• Health plan contracting and enrollment experience.
• Experience with CAQH (Council for Affordable Quality Healthcare) database and application processes.
• Experience with PAVE (Provider Application and Validation for Enrollment) & PECOS (Provider Enrollment Chain and Ownership System).
• Experience with Credential Stream for Groups credentialling database.
• Strong Microsoft Excel skills including formulas & functions pivot tables charts & graphs data sorting filtering and formatting.

Education:

• High School graduate required

Required Skills:

• Excellent verbal and written communication
• Ability to interpret adapt and apply guidelines and procedures
• Ability to establish and maintain effective working relationships with providers medical staff and coworkers

• Demonstrates accuracy organizational and problem-solving skills. Looks for ways to improve and promote quality and monitors own work to ensure quality is met
• Maintain confidentiality.
• Work independently prioritize work activities and use time efficiently

Other Considerations:

• Background check required
• Please note this job description is not designed to cover or contain a comprehensive listing of activities duties or responsibilities that are required of the employee for this job. Duties responsibilities and activities may change at any time with or without notice.
• Supervisory duties no
• Status full time
• Work Environment This position operates in a professional office environment and routinely uses standard office equipment such as laptop computer mouse and photocopier.
• Physical Demands While performing duties the employee is regularly required to talk hear read write type and respond. Specific vision abilities required by this job include close vision and ability to adjust focus. This position requires the ability to open cabinets at various levels bend stand stoop and drive as necessary.

Language Skills

While performing duties the employee is regularly required to talk hear read write type and respond in English and understand clinical/medical vocabulary written and spoken.

Vision Requirements

Vision requirements include close vision ability to adjust focus and see color.

Physical Demands

Physical requirements may vary slightly and should be reviewed with your manager. In general this position requires the ability to lift up to 35 pounds unassisted; ability to stand for extended periods of time and to perform repetitive stooping walking stretching reaching and some sitting; ability to use full range of body motions required to lift patients wear a lead apron and lift and move supplies. Must be able to safely ascend and descend stairs as a core part of the job with or without reasonable accommodation when no elevator or lift is present.

Work Environment

Job required tasks routinely involve a potential for mucous membrane or skin contact with blood body fluids tissues or potential spills or splashes. Use of appropriate personal protection measures is required for every healthcare provider in these positions. Require to routinely use standard office equipment such as laptop computer mouse and photocopier.

About Balboa United

Beginning in 1973 Balboa has grown from two physicians to a comprehensive nephrology team of 52 board certified physicians and 8 advanced practitioners. On January 1 2018 Balboa Nephrology Medical Group (BNMG) launched Balboa United a full-service medical practice management services organization. From one small office BNMG now has 24 clinical offices throughout San Diego Imperial Orange and Riverside counties. In addition to office and hospital-based patient care Balboa physicians manage the dialysis treatments of approximately 4500 patients at 88 dialysis centers and conduct Nephrology based clinical research at 6 centers throughout Imperial and San Diego counties (California Institute of Renal Research).

• EEO Statement Balboa United is an equal opportunity employer and makes employment decisions on the basis of merit. We want to have the best available person in every job. Our Company policy prohibits unlawful discrimination based on race color creed religion (including religious dress & grooming) sex (including pregnancy childbirth or related medical conditions) gender (including gender identity and gender expression) marital status registered domestic partner status military status age national origin or ancestry physical or mental disability medical condition (including cancer and genetic characteristics) genetic information sexual orientation or any other basis protected by applicable federal state or local law. We also prohibit unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has or is perceived as having any of those characteristics. The Company is committed to compliance with all applicable laws providing equal employment opportunities. This commitment applies to all persons involved in our operations and prohibits unlawful discrimination by any employee of Balboa United including managers and co-workers. If you believe you have been subjected to any form of unlawful discrimination submit a written complaint to your manager or Human Resources (HR). Your complaint should be specific and should include the names of the individuals involved and the names of any witnesses. If you need assistance with your complaint or if you prefer to make a complaint in person contact the Companys Human Resources Department. We will immediately undertake an effective thorough and objective investigation and attempt to resolve the situation.

Required Experience:

Unclear Seniority