Provider Credentialing & Enrollment Lead

Position Summary: 

The Provider Credentialing and Enrollment Lead supports credentialing department activities related to initial credentialing and recredentialing processes at San Ysidro Health. The Provider Credentialing and Enrollment Lead will be responsible for complex tasks within the department and serve as a secondary contact for technical components of activities related to credentialing and provider enrollment.

Essential Functions of the Job:

• Work loosely with credentialing and provider enrollment specialists, and credentialing manager to complete provider credentialing and enrollment activities.
• Gather, organize, and submit initial credentialing applications timely and accurately.
• Work closely with Human Resources Talent Acquisition Partners to identify and communicate delays with onboarding new providers.
• Oversee the collection of all pertinent primary source verifications for applicable licensed providers.
• Validate and maintain San Ysidro Health and contracted health plan credentialed provider directories.
• Resolve internal and external credentialing and provider enrollment matters.
• Maintain knowledge of current health plan and agency requirements for credentialing and provider enrollment.
• Assist onboarding providers with required managed care plan training(s).
• Travel to San Ysidro Health locations to obtain required signatures and paperwork may be required.

Additional Duties and Responsibilities

• Must be able to multi-task and work in a demanding environment, have strong attention to detail with the ability to work autonomously.
• Must be an initiative-taking individual with excellent organizational skills to manage large volumes of information and multiple assignments.
• Possesses strong customer focus and expertise in setting and managing customer expectations.
• Update departmental policy, procedures, desk aids, and workflows as needed.
• Perform other job-related duties as needed, assigned, or requested.

Job Requirements

Education Required:

• High School Diploma or GED equivalent. 

Experience Required:

• Minimum of 3 years of credentialing or related administrative healthcare experience

Certifications Preferred: N/A

Verbal and Written Skills Required to Perform the Job:

• Written Communications: Ability to communicate clearly & effectively in written English with internal & external customers. 
• Oral Communications: Ability to comprehend & converse in English to communicate effectively with medical center staff, families & external customers.

Technical Knowledge and Skills Required to Perform the Job:

• Basic computer skills required.
• Health Plan portals, MS Office (Excel, Power Point, Word).
• Must type approximately 35 wpm.
• Ability to proficiently maneuver through all electronic applications used for the job.
• Ability to work collaboratively in small teams to improve the operations of immediate work group by offering ideas, identifying issues, and respecting team members.

Equipment Used:

• Computers, Software systems, Scanner, Telephones, Copy and Fax Machines.

Working Conditions and Physical Requirements:

• Prolonged, extensive, and considerable standing/sitting/walking/lifting.

Universal Requirements:

Pre-employment requirements include I-9, physical, positive background and reference check results, complete application, new hire orientation, pre-employment PPDs. Compliance with all mandated vaccinations and all boosters is a term and condition of employment.