Credentialing Specialist

About Our Company

At Altais, we’re looking for bold and curious clinicians and innovators who share our passion for enabling better health care experiences and revolutionizing the healthcare system for physicians, advanced care providers, patients, and the clinical community. At Altais, we’re building breakthrough clinical support tools, technology, and services to let doctors do what they do best: care for people. We invite you to join our growing passionate team as we change the game for the future of healthcare and enable the experience that people need and deserve. Altais family of companies include Brown & Toland Physicians, Family Care Specialists and Altais Medical Groups.

 About Your Team 

Are you looking to work with a high performing, fast growing and dynamic Credentialing team? We are 4,000 physicians, working in over 40 cities throughout California, caring for more than 500,000 patients. If you are passionate about reshaping healthcare and want to work for a mission driven organization where new ideas and innovation are valued, then we would like to meet you. 

 About Your Work 

The Credentialing Specialist will be responsible for administrative aspects of credentialing services to meet medical group, health plan and National Committee for Quality Assurance (NCQA) requirements and for maintaining accurate and up to date provider information.

You Will Focus On:

• Responsible for all aspects of credentialing/recredentialing providers, to include but not limited to verification of application/documents, mailing of requests for consideration, initial applications, approval, denial, termination letters, and accurately loading provider information in the Credentialing database.
• Responsible for all aspects of credentialing/recredentialing "Organizational Providers", to include but not limited to verification of application/documents, mailing of initial applications, approval, denial, termination letters, and accurately loading provider information in the Credentialing database.
• Responsible for processing credentialing/recredentialing applications accurately and promptly in accordance with BTP policies and procedures, health plan delegation requirements and NCQA standards. Prepare credentialing files and monthly matrices for presentation to the Credentialing Committee; responsible for confirming the completeness of information and all documentation prior to presentation.
• Responsible for updating database and communicating provider changes to contracted health plans and BTMG departments via standardized report(s).
• Coordinate credentialing and re-credentialing processes, maintaining task grids and tickler systems to assure follow up and completion. Maintain communication with Medical Services and Care Management Departments to ensure review processes are completed in a timely manner.
• Responsible for accurate input and modifications to the credentialing database, which includes performing audits to assure accuracy.
• Responsible for processing the rosters (i.e. additions, changes, and terminations) from hospital-based physician groups and sub-delegated Independent Physician As/Medical Groups.
• Support and maintain database problems and modifications. Monitor database performance; investigate and resolve database questions and concerns, making modifications, as necessary.
• Prepare materials and files necessary to comply with external audits by payors and/or governmental agencies. Maintain ongoing communication with health plan representatives, contracted providers and BTP departments. Perform follow up and complete requests, as necessary.
• Disseminate new/modified professional information to health plans and BTP departments.
• Develops, maintains, and provides reports from the department database and prepares custom reports, data searches and/or data analysis in response to specific requests by internal or external customers.
• Orient new staff to Credentialing Department processes, including appropriate database use, capabilities, reporting, security, etc.
• Handles telephone calls for the department, assists callers by conveying their issues to the appropriate individual or department and performing follow-up, as required.

The Skills, Experience & Education You Bring

• Minimum Experience: 2-4 years of related healthcare experience, IPA or physician practice experience in an operational role preferred; Certified Provider Credentialing Specialist (CPCS).
• Excellent computer skills including Microsoft Office (Word, Outlook, Excel, PowerPoint).
• Use independent judgment and initiative within established policies and procedures.
• Ability to Interact and maintain excellent relationships with all levels of staff and management and external contacts to support compliance and high levels of service.
• Excellent communication skills, both written and verbal.
• Excellent organizational skills.
• Ability to obtain, synthesize and analyze data and recommend solutions.
• Ability to work on multiple projects concurrently.
• Ability to draft materials, including presentations, handouts and communications.
• Possesses a learning and growth mindset; creative thinker.

You Share our Mission & Values 

• You are passionate about improving the healthcare experience and want to be part of the Altais mission.
• You are bold and curious – willing to take risks, try new things and be creative.
• You take pride in your work and are accountable for the quality of everything you do, holding yourself and others to a high standard.
• You are compassionate and are known as someone who demonstrates emotional intelligence, considers others when making decisions and always tries to do the right thing.
• You co-create, knowing that we can be better as a team than individuals.  You work well with others, collaborating and valuing diversity of thought and perspective.   
• You build trust with your colleagues and customers by demonstrating that you are someone who values honesty and transparency.

Altais values the contribution each Team Member brings to our organization. Final determination of a successful candidate’s starting pay will vary based on several factors, including, but not limited to education and experience within the job or the industry. The pay scale listed for this position is generally for candidates that meet the specified qualifications and requirements listed on this job description. Additional pay may be determined for those candidates that exceed these specified qualifications and requirements. We provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs.

The anticipated pay range for this role is listed in our salary posting for transparency but may vary based on factors including the candidate’s qualifications, skills, and experience.

Altais and its subsidiaries and affiliates are committed to protecting the privacy and security of the personal information you provide to us. Please refer to our ‘CPRA Privacy Notice for California Employees and Applicants’ to learn how we collect and process your personal information when you apply for a role with us.

Physical Requirements: Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork – Activity level: Sedentary, frequency most of workday.

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.