Credentialing &Contracting System Admin in Orange at Prospect Medical Systems

Date Posted: 12/22/2020

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    600 City Parkway West
    Orange
  • Experience:
    Not Specified
  • Date Posted:
    12/22/2020
  • Job ID:
    17398

Job Description

Credentialing &Contracting System Admin

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

This position is responsible for routine administration of the eVIPs credentialing and contracting system. This will include making approved configuration changes through the user interface, maintenance of user security and monitoring system data quality. This individual will also be the first line of support for application issues and questions. 

Job Responsibilities/Duties

  • Performs routine system configuration, maintenance and audit as directed.
  • User Security Profile Changes
  • User Account MACD and Periodic Audit
  • Initial Diagnostic of User Reported Issues Maintain or exceed SLAs for assigned work for quality, quantity and communication measures.
  • Adheres to change management and source control policies.
  • Maintains application defect and enhancement request log. Opens and manages vendor owned issues to resolution.
  • Maintains documentation of work requested and work performed in both the work management system (ticketing/tracking) and knowledge management systems.
  • Verifies and remediates external data as necessary for successful import.
  • Manages and reconciles the application license inventory.
  • Co-manages vendor relationship. Ensures vendor meets agreed upon deliverables and escalates issues or concerns.
  • Chairs and coordinates application governance.
  • Develop and monitor data quality indicators. Work with necessary departments and individuals to remediate to and maintain data quality standards.
  • Conducts initial training for system users
  • Evaluation and Recommendation of Upgrades and Enhancements
  • Monitoring Integration Exception Logs and Resolving Issues (IDX, Faxing, Verification)
  • Requirements Gathering and Development of Vendor SOWs Development of basic SSRS Reports.
  • Duties as assigned by Management.

Qualifications

Minimum Education: College degree or equivalent experience.

Minimum Experience: A minimum of two (2) years of experience in a health plan or IPA setting. Minimum one (1) year hands on experience with a credentialing and contracting system in an administrative role or 2 years of experience in end user role. Expert knowledge of credentialing and contracting systems required. Basic knowledge of IPA or health plan operations required. Basic understanding of contracting, credentialing, health plan requirements and related concepts required (ex: delegated functions, contracted vs. non-contracted, DOFR, rosters). Basic project management skills required. Basic presentation skills required. Good verbal and written communication skills required. Good self-management skills required. Must be able to extract and manipulate data using SQL Management Studio and Reporting Services. Must be proficient in Microsoft Office suite with strong Excel data manipulation skills. Must have advanced reasoning and problem-solving abilities and planning skills.  Individuals must be motivated, able to establish rapport and interact well with individuals on all levels while maintaining a professional image and attitude

Req. Certification/Licensure: None.

Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals, benefit eligible positions will receive:

  • Company 401K
  • Medical, dental, vision insurance
  • Paid time-off
  • Life insurance

Prospect Medical Systems has a zero-tolerance policy regarding the use of drugs and alcohol.  Our Company is committed to maintaining a productive, drug free workplace that keeps employees and patients safe from harm.  For this reason, we require applicants to pass a screening for drug use as a condition of employment.  This includes: alcohol, marijuana, cocaine, opiates and methamphetamines.

How to Apply

To apply for this role, or search our other openings, please visit http://pmh.com/careers/ and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law: https://www.eeoc.gov/ 

Keywords: Credentialing, Contracting, IPA, Health Plans, SQL, Excel, Data Reporting.



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