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Careers at OPTIMA
OPTIMA is always looking for high quality individuals to join the OPTIMA team in Las Vegas, Nevada. If you are looking for a change in your current career or to start a new career with an 'employee focused' company.
Send all resumes to jobs@opscredentialing.com for consideration
Current Open Positions as of January 11th, 2012
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POSITION: Credentialing Specialist
DEPARTMENT: Provider Services
DATE: 1/05/2012
REVISION DATE:
REPORTS TO: Credentialing Manager
FLSA: ExemptPOSITION SUMMARY:
This position performs the credentialing work as outlined in the policies and procedures. Assures all provider privileges and licenses are kept current and conducts credentialing functions including, but not limited to, processing applications, obtaining licenses, DEA, updating credentialing database in accordance with Optima’s policies as well as complying with all state and federal requirements.
ESSENTIAL JOB FUNCTIONS:
- Performs the credentialing processes for all initial applications and reappointments in a timely and complete manner.
- Performs analysis and appropriate follow-up of each initial application and reappointment. Works with physicians, professional staff and physicians' office staff to acquire necessary materials and information.
- Builds strong working relationships with assigned business units, clinics and provider offices. Provides assistance and excellent customer service to these internal clients.
- Responds to incoming calls and makes outbound calls as required to resolve credentialing issues. Provides assistance and excellent customer service to external customers.
- Uses systems to provide statistical data, prepare issues list(s) and communicate with clients and providers accurately and timely.
- Responsible for other duties in the department including mail disbursement, supply management and administrative duties as assigned.
- Adhere to department policies and procedures including timely delivery of completed work and use of resources.
- Keeps supervisor informed of potential credentialing issues.
- Other duties, as assigned.
QUALIFICATIONS:
The following requirements represent the knowledge, skill and/or ability required for the position:
- CPCS NAMSS certification preferred.
- Bachelor’s or Associate degree with two years managed care or healthcare setting credentialing experience or high school diploma and five years managed care or healthcare setting credentialing experience.
- Excellent verbal, written and interpersonal communication skills.
- Compliance with established policies, procedures, regulatory and accreditation requirements as well as applicable professional and performance.
- Ability to manage multiple competing priorities in a chaotic, demanding environment.
- Ability to focus on priorities, complete goals & meet deadlines.
- Strong organizational abilities, proficiency in Professional Customer Service, oral and written communications.
- Accurate and efficient keyboarding with strong competencies in the use of common office software applications.
- Strong ability to create spreadsheets to analyze and present data.
- Effective team working skills and the ability to meet deadlines and productivity standards.
- Ability to direct and coordinate with dedicated Document Processor.
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POSITION: Credentialing Specialist
DEPARTMENT: CVO
DATE: 1/05/2012
REVISION DATE:
REPORTS TO: Credentialing Manager
FLSA: ExemptPOSITION SUMMARY:
The Credentialing Specialist is responsible for credentialing and recredentialing practitioners for client facilities and/or health plans in accordance with the contract as well as NCQA, CMS, and the Joint Commission. Conducts credentialing functions including, but not limited to, processing applications, performing primary source verifications, updating credentialing database in accordance with Optima’s policies as well as complying with all state and federal requirements.
ESSENTIAL JOB FUNCTIONS:
- Perform the initial and recredentialing credentialing functions on behalf of client health plan/facility practitioners.
- Review applications for completion and accuracy and ensure appropriate follow-up; monitor and report on the credentialing progress of each practitioner.
- Maintain accurate up-to-date data in credentialing database.
- Ensure timely and accurate credentialing and recredentialing application submissions for each practitioner as it relates to each client health plan/facility; monitor and report progress of each practitioner.
- Enroll practitioners with all appropriate client/health plans; monitor and report on credentialing progress of each practitioner.
- Respond to all practitioner, client/health plan and internal inquiries in a timely (within 24 hours) and responsive manner.
- Monitor expiring licensure and certifications with practitioners within the prescribed timeframes as outlined in the policies and procedures and ensure renewal and upload into database in a timely manner.
- Conduct sanctions and compliance monitoring and alert manager of any undisclosed negative findings immediately.
- Adhere to department policies and procedures including timely delivery of completed work and use of resources.
- Keeps supervisor informed of potential credentialing issues.
- Other duties, as assigned
QUALIFICATIONS:
The following requirements represent the knowledge, skill and/or ability required for the position:
- CPCS NAMSS certification preferred.
- Bachelor’s or Associate degree with two years managed care or healthcare setting credentialing experience or high school diploma and five years managed care or healthcare setting credentialing experience.
- Knowledge of and experience with NCQA, URAC, CMS and/or the Joint Commission credentialing standards.
- Demonstrated ability to work independently.
- Ability to manage multiple projects.
- Strong analytical skills to assess compliance, record, analyze and interpret data into meaningful reports.
- Strong communication skills, both verbal and written.
- Systems knowledge including proficiency with Microsoft Office programs, scanning and commercial credentialing software.
- Demonstrated ability and commitment to excellent customer service to maintain and ensure effective working relationships with internal and external customers.
- Ability to adapt to change and meet tight deadlines.
- Excellent attention to detail and high degree of accuracy.
- Requires astute judgment in human relations skills to interface and communicate in an articulate and sensitive manner with practitioners, administrators, legal counsel and client credentialing personnel.
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POSITION: Document Processor
DEPARTMENT: Provider Services
DATE: 1/05/2012
REVISION DATE:
REPORTS TO: Credentialing Manager
FLSA: Non-exemptPOSITION SUMMARY:
This position performs the document management work as outlined in the policies and procedures. Obtains all documents needed to assist the credentialing specialist in completing the necessary documents for hospital / health plan and licensure applications. The incumbent maintains records and the integrity of highly confidential information that is protected discovery by applicable state statutes.
ESSENTIAL JOB FUNCTIONS:
- Performs the gathering of all documents to build the provider’s credentialing file.
- Performs analysis and appropriate follow-up of each missing document to complete the provider’s file. Works with physicians, professional staff and physicians' office staff to acquire necessary materials and information.
- Builds strong working relationships with assigned business units, clinics and provider offices. Provides assistance and excellent customer service to these external clients.
- Responds to incoming calls and makes outbound calls as required to resolve document procurement issues. Provides assistance and excellent customer service to external customers.
- Uses OPTIMA Virtual Office systems to provide statistical data, prepare issues list(s), reports, grids, and communicate with clients accurately and timely.
- Responsible for other duties in the department including mail disbursement, supply management, mailing of applications, and administrative duties as assigned.
- Responsible for maintaining current provider information in the OPTIMA Virtual Office and on all client grids.
QUALIFICATIONS:
The following requirements represent the knowledge, skill and/or ability required for the position:
- High school diploma or GED and 1-2 years relevant professional administrative experience.
- Excellent verbal, written and interpersonal communication skills.
- Compliance with established policies, procedures, regulatory and accreditation requirements as well as applicable professional and performance standards.
- Ability to manage multiple competing priorities in a chaotic, demanding environment.
- Ability to focus on priorities, complete goals & meet deadlines.
- Strong organizational abilities, proficiency in Professional Customer Service, oral and written communications.
- Accurate and efficient keyboarding with strong competencies in the use of common office software applications.
- Ability to create spreadsheets to analyze and present data.
- Effective team working skills and the ability to meet deadlines and productivity standards.
- Understanding of medical terminology, and a broad understanding of medical insurance laws and guidelines, insurance policies and coverage types, physician billing procedures and payment policies.
- 95% or better accuracy rating.
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POSITION: Document Processor
DEPARTMENT: CVO
DATE: 1/05/2012
REVISION DATE:
REPORTS TO: Credentialing Manager
FLSA: Non-exemptPOSITION SUMMARY:
The Document Processor is responsible for document processing and management to assist the Credentialing Specialist in credentialing and recredentialing practitioners for client facilities and/or health plans in accordance with the contract as well as NCQA, CMS, and the Joint Commission. Assists with credentialing functions including, but not limited to, processing applications, performing primary source verifications, updating credentialing database in accordance with Optima’s policies as well as complying with all state and federal requirements.
ESSENTIAL JOB FUNCTIONS:
- Assist Credentialing Specialist with the initial and recredentialing credentialing functions on behalf of client health plan/facility practitioners.
- Maintain accurate up-to-date data in credentialing database.
- Maintains document processing to include accurate scanning, upload and retrieval of documents in the Optima database.
- Filing, faxing, assisting with follow-up phone calls to clients and practitioner offices and other administrative duties as required.
- Respond to all practitioner, client/health plan and internal inquiries in a timely (within 24 hours) and responsive manner.
- Monitor expiring licensure and certifications with practitioners within the prescribed timeframes as outlined in the policies and procedures and ensure renewal and upload into database in a timely manner.
- Conduct sanctions and compliance monitoring and alert manager of any undisclosed negative findings immediately.
- Adhere to department policies and procedures including timely delivery of completed work and use of resources.
- Keeps supervisor informed of potential credentialing issues.
- Other duties, as assigned.
QUALIFICATIONS:
The following requirements represent the knowledge, skill and/or ability required for the position:
- High school diploma or GED and 1-2 years relevant professional administrative experience.
- Demonstrated ability to work independently and self-starter.
- Ability to manage multiple projects.
- Strong analytical skills to assess compliance, record, analyze and interpret data into meaningful reports.
- Good communication skills, both verbal and written.
- Systems knowledge including proficiency with Microsoft Office programs, scanning and commercial credentialing software.
- Demonstrated ability and commitment to excellent customer service to maintain and ensure effective working relationships with internal and external customers.
- Ability to adapt to change and meet tight deadlines.
- Excellent attention to detail and high degree of accuracy.
- Requires astute judgment in human relations skills to interface and communicate in an articulate and sensitive manner with practitioners, administrators, legal counsel and client credentialing personnel.
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POSITION: Document Scanner
DEPARTMENT: CVO
DATE: 1/05/2012
REVISION DATE:
REPORTS TO: Credentialing Manager
FLSA: Non-exemptPOSITION SUMMARY:
The Document Scanner is responsible for document scanning to assist the CVO team with credentialing and recredentialing practitioners for client facilities and/or health plans in accordance with the contract as well as NCQA, CMS, and the Joint Commission.
ESSENTIAL JOB FUNCTIONS:
- Assist CVO team by accurate, efficient management of the document scanning process.
- Maintain accurate up-to-date data in credentialing database.
- Manages document processing to include accurate scanning, upload and retrieval of documents in the Optima database.
- Filing, faxing, assisting with follow-up phone calls to clients and practitioner offices and other administrative duties as required.
- Other duties, as assigned
QUALIFICATIONS:
The following requirements represent the knowledge, skill and/or ability required for the position:
- High school diploma or GED and 1-2 years relevant professional administrative experience.
- Demonstrated ability to work independently and self-starter.
- Ability to manage multiple projects.
- Good communication skills, both verbal and written.
- Systems knowledge including proficiency with Microsoft Office programs, scanning and commercial credentialing software.
- Demonstrated ability and commitment to excellent customer service to maintain and ensure effective working relationships with internal and external customers.
- Ability to adapt to change and meet tight deadlines.
- Excellent attention to detail and high degree of accuracy.
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POSITION: Corporate Human Resources Recruiter
DEPARTMENT: Human Resources
DATE: 1/11/2012
REVISION DATE:
REPORTS TO: Chief Executive Officer
FLSA: ExemptPOSITION SUMMARY:
The Corporate Human Resources Recruiter is responsible for delivering all facets of recruiting success throughout the organization. This will be achieved through the development of local and national recruiting plans, employing traditional sourcing strategies and resources as well as developing new, creative recruiting ideas. The Corporate Human Resources Recruiter will play a critical role in ensuring we are hiring the best possible talent.
PRIMARY OBJECTIVES:
- Develop and execute recruiting plans.
- Network through industry contacts, association memberships, trade groups and employees.
- Coordinate and implement college recruiting initiatives.
- Administrative duties and recordkeeping.
ESSENTIAL JOB FUNCTIONS:
- Develop and Execute Recruiting Plans
- Work with hiring managers on recruiting planning meetings.
- Create job descriptions.
- Lead the creation of a recruiting and interviewing plan for each open position.
- Efficiently and effectively fill open positions.
- Conduct regular follow-up with managers to determine the effectiveness of recruiting plans and implementation.
- Develop a pool of qualified candidates in advance of need.
- Research and recommend new sources for active and passive candidate recruiting.
- Build networks to find qualified passive candidates.
- Post openings in newspaper advertisements, with professional organizations, and in other position appropriate venues.
- Utilize the Internet for recruitment.
- Network Through Industry Contacts, Association Memberships, Trade Groups and Employees
- Locate and document where to find ideal candidates.
- Aid public relations in establishing a recognizable "employer of choice" reputation for the company, both internally and externally.
- Communicate with managers and employees regularly to establish rapport, gauge morale, and source new candidate leads.
- Create contacts within industry.
- Attend local professional meetings and membership development meetings.
- Maintain regular contact with possible future candidates.
- Coordinate and Implement College Recruiting Initiatives
- Coordinate college recruiting initiatives.
- Attend career fairs for recruiting and company recognition.
- Develop working relationships within colleges to aid in recruiting.
- Give presentations at colleges, attend student group meetings, and increase college awareness of the company before and after career fairs.
- Administrative Duties and Record Keeping
- Manage the use of recruiters and headhunters.
- Review applicants to evaluate if they meet the position requirements.
- Conduct prescreening interviews.
- Develop and maintain all pertinent applicant and interview data in the Human Resources Information System (HRIS).
- Assist in performing reference and background checks for potential employees.
- Assist in writing and forwarding rejection letters.
- Assist in interviewing and selecting employees onsite.
- Assist in preparing and sending offer packages.
- Assist in preparing and sending new employee orientation packages.
- Perform other special projects as assigned.
