Lori Cadle Email & Phone Number

San Bernardino County, California, United States

Upland, Ca

- Provide ongoing provider education and office staff orientation programs based on contract benefit and regulatory requirements- Conduct face-to-face meetings with assigned providers according to department standards;- Provide interpretation and clarification of policies and procedures- Maintain new and existing provider relationships to promote efficient delivery of services to providers- Follow up and resolve providers’ service issues that arise, including but not limited to eligibility, claims, capitation, credentialing, encounter data and member benefit programs- Assist with the completion of strategic projects such as regulatory audit preparation, competitive analyses, RFP related projects, network expansion projects, IPA crossover analyses.- Train new Provider Services staff as appropriate.- Accountable for resolving provider issues that may cross departmental lines and involve Senior Leadership.

- Manage Credentialing staff and department activities to include processing applications and initiating verification of all information contained in applications.- Manage staff time cards using Kronos.- Maintain current knowledge of NCQA and IMQ medical staff standards and state and federal requirements.- Create and implement Credentialing Policies and Procedures, assuring NCQA guidelines are met and/or exceeded.- Coordinate and attend annual health plan credentialing delegation audits.- Perform annual oversight audit for delegated entities.- Responsible for initial practitioner orientation.- Interview and train credentials staff.