Manager, Credentialing

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  • Plantation, FL
  • Business Office
  • Full Time - Days
  • Corporate
  • Req #: 11778
  • Posted: Today
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Summary

PRIMARY FUNCTION

To lead, within a collaborative environment, the operations of the credentialing coordinators in each region. Oversees all of the day-to-day credentialing functions of provider credentialing, recredentialing, approval and enrollment. Reporting to the Director of Credentialing, this role is key in ensuring streamlining of credentialing processes and procedures. This role is both hands on and strategic in nature.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES

This list may not include all of the duties that may be assigned.

  1. Oversees the daily functions of the credentialing coordinators in each region in accordance with PA policies and procedures, NCQA, AAHC, CMS and state regulations.
  2. Monitor the maintenance and update of the applicable credentialing application. Oversees the credentialing data for all providers ensuring accuracy of data and reporting to include: certifications, renewal dates, and confirming provider credentials match the requirements of the role.
  3. Manages the process and maintains credentialing documents for providers during the onboarding process.
  4. Works collaboratively with the Credentialing Auditor to review any provider credentialing discrepancies.
  5. Monitors and reports on KPIs for processing of credentialing applications with focus on delivery of a high-quality product with the greatest efficiency.
  6. Performs all management functions for the credentialing coordinator teams. In collaboration with the Director of Credentialing, will hire, develop, coach, appraise qualified credentialing coordinators; motivate and mentor credentialing coordinators. Leads the onboarding of incoming credentialing coordinators.
  7. Develops training guides and learning/growth paths for the credentialing coordinator team.
  8. Collaborate with stakeholders and internal and external customers including other departments. Is responsible for resolving any credentialing concerns that are escalated or answering questions.
  9. Works with the Director of Credentialing in developing and improving policies and procedures related to the credentialing department. Implements process improvement measures and assists the Director in the seamless integration of new practices, and implementation of software systems, and processes.
  10. Must be able to meet time-sensitive deadlines and handle confidential and sensitive information appropriately.
  11. Performs other duties as assigned.

 

SUPERVISORY RESPONSIBILITIES

Leads a team of credentialing coordinators.
 

QUALIFICATIONS

EDUCATION: Bachelor’s degree from an accredited university required. 5 years of related experience is commensurate to the education required.

EXPERIENCE: Minimum 7 years of related professional experience in healthcare. Minimum of 2 years of management experience required. Credentialing Software knowledge strongly preferred.

LICENSURE / CERTIFICATION

Certification in medical staff services by the National Association of Medical Staff Services (NAMSS) or Certified Provider Credentialing Specialist (CPCS) preferred or obtained within 1 year of employment.

KNOWLEDGE, SKILLS AND ABILITIES

  • Presenting written and oral information in an accurate, clear, succinct, and understandable manner using correct grammar and logical flow of ideas; adapting communication style and tone to fit the situation and engage the audience.
  • Meticulously keeping track of details without becoming overwhelmed by them; being exacting, precise, and accurate; spotting minor imperfections or errors and taking action to correct them.
  • Identifying the optimal solution using principles of evidence based practice to integrate best practice, research, evidence and job organization, and/or industry expertise with the needs and requirements of the situation.
  • Being open to change and considerable variety in work activities; effortlessly adjusting to new or changing situations and unexpected events; altering one’s approach to tasks and projects with minimal loss of efficiency.
  • Using inductive and deductive reasoning to formulate general rules or principles and apply them to work; identifying flaws in logical reasoning; understanding complex conceptual relationships; accurately detecting underlying themes or patterns in data.
  • Taking an organized approach to work and planning ahead; identifying objectives aligned with business strategies, structuring work and estimating necessary time and resources; anticipating and adjusting for potential obstacles and problems; monitoring work progress.
  • Listening to and recognizing the challenges and perspectives of others; sharing information and resources; working cooperatively with others to seek common ground and achieve group goals; proactively adjusting one’s style and efforts to complement those of others on the team; valuing organizational success as much or more than individual success.
  • Proficiency with computer skills with a focus on Word and Excel
  • Must be able to meet time-sensitive deadlines and handle confidential and sensitive information appropriately.
  • Ability to analyze situations accurately and adopt effective course.
  • Works independently and is self-directed.
  • Demonstrate skills in attention to detail, organization, prioritizing and multi-tasking.
  • Credentialing software knowledge a plus.
  • Excellent verbal and written communication skills.
  • Understand and articulate CME requirements in each state and communicate those requirements to appropriate physicians.
  • Demonstrated skill and ability to coach and lead others.

TYPICAL WORKING CONDITIONS

  • Non-patient facing)
  • Remote/telework
  • Indoor
  • Operating Computer
  • Reach Outward
  • Manual Dexterity
  • Lift/Carry 10lbs or less
  • Sitting
  • Traveling
  • Bending

OTHER PHYSICAL REQUIREMENTS

  • Vision
  • Sense of sound
  • Sense of touch

 

PERFORMANCE REQUIREMENTS

Adherence to established standards as mandated by NCQA, AAAHC, state and federal rules/regulations is required.

Must be able to meet time-sensitive deadlines and handle confidential and sensitive information appropriately.

Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI (Protected Health Information) in accordance with organizational policy, Federal, State, and local regulations. The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to be an accurate reflection of the general nature of level of the job.

I have read the above job description and my supervisor has discussed it with me and I understand the responsibilities of the job for which I have been hired. I acknowledge that I have assumed responsibility for carrying out these tasks to the best of my ability and accordance with company policies

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