Credentialing Manager

Credentialing Manager

We are currently seeking a Credentialing Manager to join BCHP! This position will be a hybrid on-site and remote position at BCHP's Valhalla, NY location. This position will also require travel to additional BCHP sites as needed. Salary approx. $90,000-$120,000, negotiable based on experience. Credentialing experience required.

Job Description/Role Purpose:

The position will report to the Senior Director of Revenue Cycle Management. The Credentialing Manager is a professional who verifies and maintains credentials for licensed professionals. The role is responsible for reviewing applications, credentials, verifying qualifications, certifications, licensure, and other credentials, ensuring that information is up to date and accurate. The Credentialing Manager also handles the administrative functions associated with the credentialing process, such as data entry and records management. The role is responsible for the maintenance and accuracy of all credentialing software. The position also serves as a point of contact for credentialing related inquiries and assists in the preparation of necessary reports.

Credentialing Lead Duties

• Manages the credentialing and recredentialing process of healthcare providers, and other license professionals
• Serving as the primary contact for all credentialing and recredentialing matters
• Develop and implement policies and procedures for the credentialing and recredentialing process, ensuring they meet industry standards and organizational needs.
• Liaise with external agencies, including insurance carriers and regulatory bodies, to ensure the timely sharing of credentialing information and compliance with external standards
• Facilitate the resolution of discrepancies or concerns regarding applicants’ credentials, working closely with medical staff leadership and healthcare providers
• Maintains and updates provider records
• Performs primary source verifications
• Reviews applications for completeness and accuracy
• Verify the accuracy and completeness of provider applications, ensuring that all required documents are submitted
• Maintain accurate and up-to-date electronic and hard copy files of all credentialing documentation
• Monitor expiring licenses and credentials, proactively initiating the renewal process to avoid any disruption in services
• Assist in preparing for and participating in audits and regulatory reviews.
• Stay up to date with industry regulations and requirements, ensuring compliance at all times.
• Provide support and guidance to internal staff regarding credentialing and privileging processes
• Coordinates and schedules site visits as needed
• Creates and maintains KPI reports for provider data and credentialing activities

Job Skills and Experience

• Bachelor's degree in a health-related field or equivalent experience
• Experience in medical credentialing, health care administration, or related field
• Minimum of 2 years of experience in credentialing or provider enrollment. (NY/CT a plus)
• Excellent attention to detail and ability to work with complex documents.
• Strong knowledge of industry regulations, such as the National Committee for Quality Assurance (NCQA) and The Joint Commission (TJC) standards
• Effective communication and interpersonal skills
• Ability to work independently and collaboratively with a team
• Exceptional organizational and time management abilities
• Ability to manage multiple projects
• Knowledge of credentialing process and regulations
• MUST have own transportation and be willing to travel within the Hudson Valley region of New York and Fairfield County, Connecticut. This role requires about 25% travel.
• Certified Provider Credentialing Specialist (CPCS) highly desired but not required
• Knowledge of contract software databases a plus
• Proficient in Microsoft Office Suite

BCHP will recruit, hire, train, transfer, promote, layoff and discharge associates in all job classifications without regard to their race, color, religion, creed, national origin, alienage or citizenship status, age, gender, actual or presumed disability, history of disability, sexual orientation, gender identity, gender expression, genetic predisposition or carrier status, pregnancy, military status, marital status, or partnership status, or any other characteristic protected by law.