Credentialing Manager

Cove Behavioral Health is Searching for a Credentialing Manager to observe our process and use their expertise to create a more functional and streamlined credentialing process. This is a 1099 Contract project with 3-6 Months of employment.

Qualifications

• · Minimum of one (1) year experience in Medical Staff credentialing within Clinic, Hospital or Physician Practice setting, or applicable Medical Office experience
• · CPMSM and/or CPCS Certification by the National Association Medical Staff Services strongly encouraged
• · Excellent typing, organizational, and time management skills
• · Expert working knowledge of a variety of software including word processing, excel and Smart Sheet development and management
• · Well-developed communication (verbal and written including editing documents)
• · Excellent interpersonal communication skills and the ability to empathize with others
• · Possesses excellent judgment and the ability to maintain professional relationships and boundaries when working with internal and external clients, colleagues and organizations
• · Ability to lead by example, adhering to the highest standards of professional work ethics and confidentiality
• · Satisfactorily complete competency requirements for this position
• Advance electronic media skills
• · Share expertise with co-workers both formally and informally
• Enroll new providers and groups with government payors and coordinates, monitors, and maintain the revalidation process with government payers
• · Obtain, complete accurately, and timely submit enrollment applications and related documents and ensure provider collected information is current and accurate
• · Maintain CMS Medicare, Medicaid, PECOS, NPPES, and CAQH tracking log to ensure all necessary portals logins are active and available
• · Prepare, submit, and monitor status of provider files/applications for facility privileging
• · Complete and document credentialing of contracted network providers and facilities in accordance with applicable regulations and internal policies and procedures, to include uploading of evidence in any applicable contracting/credentialing software/applications
• · Ensure termination of enrollment with health plans upon resignation or termination of providers
• · Responsible of collaborating and advising as appropriate to limit company legal liability and escalates non-compliance issues and concerns

Responsibilities

• · The Credentialing Specialist is responsible for coordination and oversight of Medical Services staffing support
• · Works closely with Medical Staff leaders, QI department, and Administration, Human Resources, and members of the Medical Staff regarding initial and subsequent credentialing packages as required for enrollment in health plans, professional demographic tracking, collaborative practice agreements, and provider onboarding
• · Ensures compliance with regard to credentialing standards
• · Represent the Company professionally at all times through care delivered and/or services provided to all clients
• · Comply with all State, federal and local government regulations, maintaining a strong position against fraud and abuse
• · Comply with Company policies, procedures and standard practices
• · Observe the Company's health, safety and security practices
• · Maintain the confidentiality of patients, families, colleagues and other sensitive situations within the Company
• · Use resources in a fiscally responsible manner
• · Participate proactively in improving performance at the organizational, departmental and individual levels
• · Implement and maintain procedure to credential prospective new medical staff and re-credential existing medical staff for all entities within the Organization
• · Maintain current individual medical staff provider files to include all current necessary medical staff documentation and provide credentialing information in a timely manner
• · Maintain and manage professional demographics, including practice location and COIs for all Medical Staff
• · Enroll providers in all appropriate commercial health plans and maintain revalidation process
• · Complete regular follow up with the payors to ensure applications are being processed
• · Work with individual providers to ensure each provider’s CAQH database files are updated timely according to the schedule published by CMS Medicare/ Medicaid regulations
• · As directed, provide updated demographic information with supporting documents to outside participants, contracted billing entities
• · Work closely to ensure all individual providers are credentialed and recredentialed timely
• · Perform other duties as assigned
• · Develops, implements and maintains procedure to credential prospective new medical & clinical staff and re-credential existing medical staff for all entities within the Organization
• · Process two-year reappointment updates for all existing medical staff and ensures credentialing processes implemented are compliant with Accreditation standards
• · Coordinates with Medical Liability Insurance Agent to secure medical liability insurance coverage for prospective medical staff
• · Maintains credentialing database by creating and implementing procedures for medical staff licenses/certifications tracking and updating including, but not limited to, medical license, DEA, UPIN, board certifications, malpractice insurance, CMEs, CEUs, contracts, and privileges
• · Maintains current medical/clinical staff files on each individual member to include all current necessary medical /clinical staff documentation and provide credentialing information in a timely manner
• · Processes enrollments for Medicare, Medicaid and other insurance plans
• · Maintains active OIG list

Job Type: Contract

Pay: $64,188.00 - $68,211.00 per year

Schedule:

• Choose your own hours

Work Location: Hybrid remote in Tampa, FL 33605

Salary : $64,188 - $68,211