Credentialing Manager

Title: Credentialing Manager

Location: (City, State) – Hybrid (2-3 days on site Charlotte, NC)

Term: FTE

Position Overview

We are seeking an experienced Credentialing Manager for our client in the healthcare services field. The Credentialing Manager will manage a team of 2 and will be responsible for the process of verifying and validating the qualifications, experience, and licenses of healthcare professionals, such as doctors, nurses, and other licensed practitioners for our client. The Credentialing Manager will oversee a team responsible for processing credentialing and re-credentialing applications for healthcare providers, ensuring department operations comply with all regulatory standards. The CM implements policies and procedures to ensure that applications are properly verified and accurately uploaded into an online credentialing database system. Analyzes reports on applications and credentialing status to identify trends and improve the credentialing process. Prepares files for the credentialing committee and may act as a liaison to state medical licensure boards regarding the status of license applications.

Responsibilities :

• Supervises the completion of provider credentialing and re-credentialing applications and monitors applications and follows up as needed. Adheres to deadlines and enrollment schedules by tracking files through the application and re-application process
• Compiles and maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents; Conducts the enrollment and credential verification process in Modio as determined by the facilities in which they are privileged and payor credentialing
• Provide supporting documentation to provider facilities acting as a liaison for the provider
• Uses state, federal, and other organizations to maintain primary source verifications to confirm practitioners are current on all required licenses, registrations and certifications and ensure timely renewals
• Ensures compliance with applicable laws, regulations, procedures, and policies for all the facilities. Acting as a liaison to Medical Staff Offices and staff in facilities PAA has contracts with at the time of local, state, and national surveys, i.e. TJC, AAAHC, etc., and acts as a liaison between the Medical Staff offices and the practitioners to ensure their privileges remain in good standing
• Primary contact for credentialed provider "On-Boarding” and "Off-Boarding” ensuring all members of the team perform their tasks in a timely manner
• Maintains credentialing packets for all PAA Mobile/OBA staff, to be sent to the facility prior to the practitioner starting and updated annually as needed and works with the OBA team to provide state and federal vetting of potential clients
• Works directly with national practitioner certification organizations (ACCME, AAPA, NCNA, AANA) to ensure practitioners can earn appropriate credit for training they attend and provides evaluations and follow-up to ensure certificates and credits are awarded
• Ensures completion of initial payer enrollment applications and timely follow-up for PAA providers as well as their billing clients for commercial and government payers
• Audits health plan directories for current and accurate provider information
• Complete and maintain all Medicare, Medicaid and CAQH profiles for all providers
  
  

Qualifications:

• Bachelor's degree required
• Experience: A minimum of two years of experience in provider credentialing, compliance, and project management is required, along with demonstrated leadership in overseeing teams and processes
• License/Certification: One of the following certifications is required: Certified Provider Enrollment Specialist (CPES), Certified Provider Credentialing Specialist (CPCS), or Certified Professional in Medical Services Management (CPMSM)
• Language Skills: Demonstrated ability to exercise professional oral and written communication skills with all internal and external audiences
• Computer Skills: Proficiency in Microsoft Excel, Outlook, Word, and PowerPoint is required
• Reasoning Ability: Strong ability to efficiently organize and manage personal workload while effectively leading a team. Demonstrate capability to acquire and maintain in-depth knowledge of anesthesia billing operations. Proficiency in analyzing and evaluating the credentialing team's productivity and performance. Expertise in developing and implementing corrective action plans to enhance efficiency. Ability to thrive in a fast-paced environment while managing multiple priorities effectively. The physical demands described here are representative of those that must be met by any employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit, stand, walk, talk, and hear. The employee must occasionally lift and/or move up to 25 pounds and be able to work in a sitting position for long periods of time. Duties will be performed in an indoor setting. The work environment is a close office setting with several conversations going on at once. The noise level is frequently moderate, which can, for some people become distracting
  
  

Powered by JazzHR

147oko6JWy