Nature & Scope: Positional Overview
Are you a detail-oriented leader with a passion for ensuring seamless provider credentialing? Our client is seeking a Senior Credentialing Manager to join their team in a direct hire role. In this key position, you'll oversee and grow the Credentialing team, and collaborate closely with external vendors to ensure timely credentialing for new and existing providers-directly impacting revenue generation. If you're ready to lead a high-impact process and thrive in a fast-paced healthcare environment, we'd love to hear from you.
Role & Responsibility: Tasks That Will Lead To Your Success
Leadership Team Functions
- Acts as staff resource and role model for ethical, professional conduct; Has the ability to provide guidance on processes within credentialing.
- Monitors credentialing processes and identifies areas in need of improvement.
- Participates in the hiring, onboarding, and ongoing training processes of credentialing specialists
- Delegates duties and projects to appropriate staff, and monitors for accurate and prompt completion.
- Stays apprised of all relevant regulations, standards, and directives from regulatory agencies and third- party payers.
- Stays apprised of changing healthcare trends and leverages technology and automation to develop and deliver new products and services to customers.
- Demonstrates knowledge of safety policies and procedures and actively maintains a safe and positive work environment.
- Carries out other assignments or special projects as required.
Role Specific Functions
- Works with other department managers and staff-including physicians, managed care, contracting, and other professional staff-to acquire necessary materials and information for provider certification and licensure to promote organization-wide compliance with credentialing policies and procedures.
- Providers oversight of verification and payer credentialing of health care professions and credentials are in compliance with state and federal standards.
- Oversees process and organization of all-payer credentialing and re-credentialing paperwork with participating insurance companies.
- Maintains a database of practitioner's training, education, licensing, and experience information
- Key liaison with Medical Staff team, outside vendor, and IT.
- Holds team accountable for maintaining and obtaining up-to-date provider documentation.
- Assists in filling out and reviewing applications with practitioners and other applicable staff.
- Performs ongoing provider database maintenance for accuracy and completeness.
- Sets and monitors responsibilities of subordinate staff; strategically distributes tasks and workload appropriately.
- Remains compliant with and knowledgeable of rules and regulations set forth by the Health Information Portability and Accountability Act (HIPAA), Joint Commission standards, the HCQIA, the National Committee for Quality Assurance (NCQA), the Centers for Medicare & Medicaid Services (CMS), as well as state regulations-and relays this information to the necessary parties to ensure ongoing compliance organization-wide.
Skills & Experience
Qualifications That Will Help You Thrive
- Bachelor's degree in healthcare-related field or 10 years of relevant work experience required.
- Certification through National Association of Medical Staff Services (NAMSS) preferred
- At least 3 years leadership experience required
- Experience managing vendor relationships
- Exemplary problem-solving and conflict-resolution skills
- Detail- oriented
- Skilled in synthesizing a wealth of information
- Exhibits excellent time management and prioritization abilities
- Communicates effectively both one-on-one and in a group setting
- Capable of following and providing detailed instructions both orally and through written communication
- Experience with credentialing database management software preferred
- Extensive experience working with Microsoft Office Suite (Word, Excel, PowerPoint, Outlook, Access, Project