The Credentialing Manager is a key corporate functional role for the organization that administers credentialing and provider enrollment services. This role is responsible for managing and monitoring processes and procedures that support credentialing, re-credentialing, expirable data management, and ensuring compliance with state and federal regulations.

Strategic Leadership

• Analyze and implement process improvements to enhance credentialing efficiency.
• Serve as a primary resource to employees with regards to issues, interpretation and application and department policies and procedures.
• Conduct periodic audits of credentialing files and staff work product.

Operational Excellence

• Coordinates with practice management, licensing agencies, and insurance carriers to complete credentialing and re-credentialing applications.
• Develop and implement departmental controls and procedures to ensure accuracy and efficiency.
• Ensure compliance with the credentialing requirements of the health plan partners and related regulatory and accrediting agency requirements.

Collaboration and Reporting

• Collaborate with leadership on policy development and standardization of criteria/processes across the organization.
• Monitor external credential databases to ensure data is updated and ready for quick retrieval and use by interested parties.
• Oversee processes and review all reports related to adverse actions such as sanctions, licensure actions or limitations, and credentialing-related complaints.

Compliance

• Ensure compliance with state and federal regulations related to the delivery and documentation of patient care.
• Monitor the renewal of licenses and other documents subject to expiration, and ensure updates are forwarded to facilities and healthcare partners as renewals are received.
• Develops and provides regular reports and presentations on the operations and progress of credentialing functions, including activity related to approvals, denials, and appeals.

Team Development

• Direct the output of a team of employees and provide ongoing training as needed regarding new guidelines or updated processes/policies.
• Foster a positive, collaborative work environment that promotes teamwork and cross-functional cooperation.

KNOWLEDGE, SKILLS & ABILITIES

• Excellent communication skills (written and verbal), as well as exceptional people skills.
• Exceptional leadership abilities, a problem-solving mindset, and a focus on team engagement and transparency.
• Strong understanding and use of web-based credentialing applications.
• Ability to manage multiple priorities in a fast-paced environment while working professionally, courteously, collaboratively, and cooperatively as part of a team.
• Ability to build partnerships with management, staff, and stakeholders to achieve department and organizational goals and objectives.
• Attention to detail and ability to analyze large amounts of data.
• Proficient with Microsoft Office Suite, database administration, and scanning applications.

EDUCATION & EXPERIENCE

• Minimum of 5 years of credentialing experience with at least 2 years in a supervisory role.
• Bachelor's degree in business administration or a healthcare-related field.
• Master's degree and/or relevant field preferred.
• Database management skills include querying, reporting, and document generation.

SUPERVISORY RESPONSIBILITIES

Manage the Credentialing process and its associates.

WORKING CONDITIONS

General office working conditions.

Job Type: Full-time

Benefits:

• 401(k)
• Dental insurance
• Disability insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Work Location: In person