Credentialing Manager

Pathway Healthcare is a leading behavioral health organization dedicated to providing comprehensive care for individuals facing mental health challenges, and substance abuse issues. We believe in a holistic approach to treatment, addressing both physical and mental well-being to foster lasting recovery and wellness.

We value our team members and want our team members to experience a positive culture where they feel valued. Our team members have access to health benefits, including Teladoc that is free to all full-time employees, as well as PTO, and paid holidays. If you are passionate about helping people and want to be part of a team where you will be valued and have the opportunity to grow, then send us your resume!

POSITION OVERVIEW

The Credentialing Manager is responsible for overseeing the credentialing and re-credentialing of all providers with perspective payers in multiple states as well as overseeing and maintaining provider files with up-to-date information and communicating needed information/updates to various departments in a timely manner. The Credentialing Manager will also oversee the first 30 days of claims for newly enrolled providers before delegating the billing of those claims to the billing team.

ROLE RESPONSIBILITIES

• Ensure enrollment statuses are up-to-date and accurate for every payor and provider combination.
• Update enrollment statuses daily.
• Communicate enrollment status and/or enrollment status impact frequently and accurately to billing team manager and operations manager.
• Oversee the credentialing and enrollment process for all existing and new providers.
• Ensure credentialing and enrollment is done in a timely manner and in alignment with expectations of management.
• Actively participate in the credentialing and enrollment of existing and new providers.
• Communicate regularly with payors and health plans with which providers are being enrolled.
• Communicate daily with Director of Business Development as it relates to enrollment to existing and new contracts.
• Arrive to all scheduled meetings on time and prepared to participate in productive collaboration.
• Manage clearinghouse portal (previously STEM) to ensure all providers, locations, and appropriate identifiers are registered and accurate for the receipt of ERA’s and electronic VOB data.
• Manage the claims in the Enrollment Pending status to ensure timely filing and payment.
• Manage the first 30-days of claims for newly enrolled providers and new services to ensure claims are getting paid and all kinks are worked out before delegating the billing of those claims to the billing team.

Special Projects __________

• Complete and maintain credentialing and enrollment manual to include a section for each payor with which Pathway is in network:
  • Checklist per payor detailing the steps and order in which they need to be completed.
  • All forms needed for credentialing and enrollment.
  • All relevant links to online applications and portals used for credentialing and enrollment.
  • All existing contracts to which providers should be enrolled for applicable payors.
• Provide update on all issues identified during credentialing and enrollment meeting.
• Review all insurances in ECW to check for duplicates and accuracy.

QUALIFICATIONS & EDUCATION REQUIREMENTS

• Completion of an Bachelor’s degree in a related field preferred however relevant experience may be substituted.
• Minimum of 5 years of credentialing experience required.
• Knowledge of Medicare and Medicaid is a must.
• Attention to detail.
• Knowledge of Microsoft Office applications and general computer literacy
• Excellent verbal and written communication skills.
• Ability and willingness to work as part of a team
• Upbeat and self-motivated.