The Credentialing Manager is responsible for oversight of all Credentialing related functions while adhering to all state, federal, regulatory and accreditation standards. The Manager coaches the team to ensure all providers start on expected start date and all expirable documents are maintained and current.
- Oversee multiple departmental functions to support contracted facilities across all divisions.
- Manage provider credentialing process (internally / externally) to include: Internal / hospital privileges, obtaining state licenses, DEA’s, CDS within established timelines.
- Oversee expirables process in support of contract compliance.
- Ensure departmental guidelines support NCQA Compliance, Joint, CMS & DNV guidelines.
- Perform regular reviews on direct reports to foster development.
- Identify and analyze the design of jobs, work processes, work flows etc. for the department.
- Implement appropriate changes to improve effectiveness, productivity and efficiency that support overall goals of the department.
- Monitor audit results in support of quality improvements, timelines and accountability.
- Track and trend in order to promote compliance, process enhancement and efficiency.
- Ensure team is following all established processes, procedures and meeting established deadlines
- Other duties as assigned
- Reads and abides by the company’s code of conduct, ethics statements, employee handbook(s), policies and procedures and other corporate mandates, including participation in mandatory training programs
- Reports any real or suspected violation of the corporate compliance program, company policies and procedures, harassment or other prohibited activities in accordance with the reporting policies of the company
- Obtains clarification of policy whenever necessary and may use the resources available such as Compliance, Human Resources or Legal Department to do so
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.
- In depth knowledge of credentialing
- Understanding of State, Federal, regulatory Accreditation standards and policies and procedures
- Achievement-oriented with a positive, results-oriented style
- Ability to interact with internal and external customers
- Demonstrates ability to lead, manage and motivate teams.
- Flexible and adaptable in regard to learning and understanding new technologies
- Highly analytical and detail-oriented with ability to demonstrate command of details and to articulate those details at a higher level.
- Strong written, oral and interpersonal communication skills
- Highly self-motivated, directed and proactive
- Keen attention to detail
- Ability to effectively prioritize and execute tasks in a high-pressure environment
- Experience working both independently and in a, team-oriented, collaborative environment
- Able to communicate effectively within department and with members of interdisciplinary teams
- Ability to work independently and proactively in a fast-paced, dynamic environment
- Proven analytical and problem-solving abilities
- Bachelor's Degree and 3-5+ years of related experience; or equivalent combination of education and experience
- Microsoft Office Suite
- Credentialing Software (VerityStream, Echo plus)