Credentialing Manager

JOB DESCRIPTION

Position: Credentialing Manager

Reports to: Director or Network Development

Effective Date: 2/12/2025

Salary Range: $55-60,000

Position Summary:

The person in this position is responsible for creating and maintaining all credentials files, and for following the Credentialing Policy and Procedures when performing the duties associated with these tasks. This person will interact with the Provider Relations Department to ensure timely credentialing of all providers and will maintain the data base associated with the Credentialing Department. This person will also produce health plan reports on a monthly and quarterly basis and will conduct all health plan audits.

Qualifications:

· Minimum of a Bachelor’s Degree; relevant work experience may supplement degree

- CPCS Certification preferred

· At least one year of experience in a credentialing environment

· Excellent technical skills; PC/Windows including word processing and spread sheet functions

· Good communication skills

- Strong attention to detail

Core Competencies:

· Organizational Knowledge: Must be able to interpret and apply standard policies to highly variable situations · Technical Knowledge: Must have strong spreadsheet and data skills as well as knowledge of basic computer operations including Microsoft Office Suite.

Critical Success Factors:

· Ability to perform the credentialing process and to maintain timeliness of provider files

· Ability to clearly articulate policy, to collect data on providers, and to provide objective interpretation of data to providers and internal staff;

· Ability to prioritize workload to be responsive to organizational strategies

· Ability to facilitate collection and organization of data.

-Ability to comprehend and discuss reports with clients

Duties and Responsibilities:

· Assure that healthcare provider clients meet credentialing standards;

· Collect data systematically within timeliness standards;

· Participate in continuous quality improvement monitoring and activities to evaluate and improve client office processes

· Maintain compliance with certification standards

· Communicate with individual health plans by providing plan-specific reports

Job Type: Full-time

Pay: $55,000.00 - $60,000.00 per year

Benefits:

• AD&D insurance
• Dental insurance
• Flexible schedule
• Health insurance
• Life insurance
• Paid time off

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Experience:

• Credentialing: 1 year (Required)

License/Certification:

• Provider Credentialing Specialist Certification (Preferred)

Ability to Relocate:

• Louisville, KY 40243: Relocate before starting work (Required)

Work Location: Hybrid remote in Louisville, KY 40243

Salary : $55,000 - $60,000