What are the responsibilities and job description for the Ambulatory Surgery Center Credentialing Manager position at Lexington Surgery Center?
JOB SUMMARY:
The Credentialing Manager oversees the operations of the credentialing department to develop, manage and monitor processes and procedures that support the credentialing, re-credentialing, expirable data management, and delegated credentialing contract processes. Ensures compliance with the appropriate accrediting and regulatory agencies. Supervises the day-to-day management of the overall credentialing process and database management.
ESSENTIAL FUNCTIONS:
· Manage the preparation and maintenance of credentialing files and reports for all individual providers. Includes maintenance of credentialing software, provider rosters and spreadsheets to comply with group requirements.
Utilizes CredentialMyDoc Software.
· Process and file applications with payors according to each payors’ individual requirements and address/correct discrepancies as requested by payors.
· Ensure all follow up steps are completed until payor approval/completion is obtained.
· Ensure provider practice change notifications and follow up duties are completed until confirmed by payors and portals.
· Update NPI records according to provider specifications.
· Enroll providers & maintain enrollment in Medicare portal and Medicaid TMHP portals.
· Enroll facilities in Medicare/Medicaid program
· Track provider licensure and Board expirations and ensure timely processing CAQH, payor updates.
· Ensure requests for re-credentialing for both providers and facilities are complete.
· Review & process or assign all requests from payers for credentialing information/updates.
· Prepare new contracts and product documentation to be reviewed by Administrator
· Answer questions, process requests from staff/providers related to credentialing information.
· Manage the preparation and maintenance of facility credentialing files and reports including credentialing software, facility rosters and spreadsheets
· Ensure all credentialing documentation meet standards set by carriers.
· Address enrollment disconnects in regard to facility and providers.
· Ensure monthly payor rosters for new providers are complete.
· Assist in quarterly CAQH attestation.
· Serve as liaison between Lexington Surgery Center and outside organizations and external customers.
Job Type: Full-time
Work Location: In person
