- Welcome to Central City Community Health Center where our mission is to provide quality patient centered health care to low-income, undeserved individuals. With 15 direct clinic locations in Los Angeles, North Orange County and the Inland Empire, as well as outpatient support to almost 700 private Residential Care facilities, our core value of exceeding patient relationships in a culturally sensitive manner translate into an environment where the welfare of our patients always comes first. We seek the best trained clinical and professional staff and strive to provide care in a culturally sensitive manner.
To support our mission we currently have a need for Credentialing and Grievance
In this role you will fulfill the following key responsibilities:
- Process credentialing application for all providers by enrolling providers with all IPAs according to servicing counties for Board and Care and employees.
- Maintain CHDP Program enrollment for both qualifying providers and clinic sites.
- Updates all CAQH accounts as requested per providers.
- Enroll providers with PECOS.
- Process Clinic CHDP re-certifications.
- Enroll providers with CHDP.
- Update all providers’ medical licenses, DEA, and malpractice with IPA/s as they request when licenses are expired.
- Track all credentialing applications per provider as they are sent to IPA.
- Assist the Health Plans with information requested for Providers and FSR.
- Request needed information from Providers and update files (DEA, License, CV, ETC).
- Provide Health Plans and IPAs with information needed in regards to clinic addresses and providers rendering services.
- Provide customer service to all CCCHC clinics; answer all calls from providers, clinics, health plans regarding provider enrollments, credentialing, grievances, authorizations, referrals, etc. (research answers and return calls).
- Submit any information that health plans requests.
- Maintain current clinic and Board and Care provider rosters.
- Create termination letters for providers that will no longer be affiliated with CCCHC to health plans and IPAs.
- Transfer lives from terming providers to active providers with CCCHC.
- Serve as customer service for IPAs; responsible for advising IPAs of all provider changes and/or updates, including clinic assignments, new providers, new contracts, etc.
- Consistently demonstrate and uphold CCCHC’s principle of providing quality health and human services to the medically underserved and low-income populations in a culturally sensitive manner.
- All other duties as assigned.
- Special Knowledge, Skills, Abilities and Attributes:
- Demonstrated ability to exercise sound judgment.
- Ability to communicate clearly and concisely.
- Ability to plan and be organized.
- Ability to work well under pressure, take initiative and be flexible and cooperative.
- Ability to maintain confidentiality of patient information and Company records.
- Ability to work with psychiatric population.
- Ability to work effectively with both employees and managers.
- Ability to convey a positive and professional image to patients and employees.
- Must be able to operate computer and office equipment and software.
- Ability to work with people of diverse cultures and diverse socioeconomic situations.
- Must be able to make decisions and perform job duties with minimal supervision.
- Must feel comfortable with discussing and informing patients with information regarding sensitive issues.
- Required to know, follow, and enforce safe work practices, and be aware of company policies and procedures related to job safety, including safety rules and regulations.
- Reliable transportation, automobile insurance, and current CA Driver License.
Education and Experience Requirements
- High school diploma or GED required.
- Bilingual (Spanish/English) required.
Normal clinic environment with:
- Physical requirements for this position include: routinely walking and/or standing, hearing, seeing, speaking, feeling, reaching and repetitive motions.
- Ability to handle multiple tasks while also being tactful, diplomatic, and empathetic.
- Ability to organize, schedule work effectively, and work independently with minimal supervision.
- Ability to communicate effectively and tactfully with patients, customers, managers and other levels of personnel, in person and on the telephone.
- Ability to pay close attention to detail.
We offer a dynamic work environment with competitive salaries and benefits. Central City provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Central City complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities.
To Apply - Follow instructions below and visit our Application Upload Center.