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Behavior Frontiers · 1 month ago

Credentialing Manager

El Segundo, CA

Full-time

Hybrid

Mid Level

$75K/yr - $85K/yr

3+ years exp

Behavior Frontiers is an industry leader in ABA treatment for autism and other special needs, seeking a Credentialing Manager to oversee the credentialing process. The role involves managing daily operations, maintaining provider files, and ensuring compliance with legal and regulatory standards while fostering relationships with funding sources.

Child CareHealth CareMedical DeviceTraining

Responsibilities

Supervise/manage the day-to-day operational functions of credentialing and recredentialing process and personnel to include workflow management, troubleshooting, log management, process updates, reporting and training

Create and maintain individual provider files including credentialing status and supporting documentation

Track and ensure accuracy of new/promoted provider credentialing and/or application status in database, and make updates for existing providers

Act as a resource for other managers and coworkers and respond to internal and external requests for credentialing information and documentation

Work closely and transparently with internal departments and external partners

Regularly report updated provider and location rosters to funding sources and internal departments

Support contract develop goals to include researching new funding sources, unique contracting process requirements, data gathering, forms completion, submissions, tracking, follow up and reporting

Keep abreast of relevant legal, regulatory, and legislative changes related to credentialing, contracting and licensing

Maintain comprehensive working knowledge of contractual relationships including credentialing and contracting requirements by funding source

Develop and maintain positive and cooperative relationships with funding source representatives and coworkers

Contribute to the on-going development of new funding sources

Complete special projects as assigned

Maintain confidentiality in matters of company operations, personnel, and clients

Perform other duties, as assigned

Qualification

Credentialing experienceNCQA guidelines knowledgeRelationship developmentOrganizational skillsProblem-solving abilitySelf-directedMulti-taskingVerbal communicationWritten communicationAttention to detailDecision makingFlexibilityAdaptability

Required

3-5 years credentialing experience in the Behavior Health or related industry

Knowledge of NCQA credentialing guidelines

Experience developing and maintaining relationships with a variety of funding sources

Must be self-directed, exercise initiative, discretion and seek guidance as appropriate

Superior organizational and multi-tasking abilities with high attention to detail

Ability to make sound decisions, prioritize effectively and problem solve

Ability to effectively and professionally represent BF to funding sources and external partners

Ability to work independently in a fast-paced environment, flexible and adaptable

Excellent verbal and written communication skills

Bachelor's degree required

Provide negative TB test results

Ability to clear FBI & DOJ fingerprinting

Benefits

On-demand paychecks thru DailyPay - get paid on your own schedule!

401K Plan with company match after 6 months of employment

Paid Personal Time Off

Paid Holidays

Paid Sick Leave

Medical, Dental and Vision insurance

Opportunities for career advancement

Performance and promotion raise

Paid Maternity Leave - Up to 9 Weeks

Free Telehealth:Free 24/7 access to a doctor via telehealth for you and your dependents with no limits and no co-pays

Free Telehealth Mental Health:Free access to a mental health counselor via telehealth for you and your dependents (over age 13) with no limits or co-pays

Employee Assistance Program:Free access to some support services (financial, legal, counseling, etc.)

Fitness:Discounted monthly gym membership to 12,000 gym locations nationwide, as well as free access to workout videos

Deals:Exclusive discounts and savings to 500+ companies and more!

Travel:Discounts on travel essentials including hotels, rental cars, flights, excursions, and more!

Lab Testing Discounts:10-80% off costs of routine lab work

New Benefits Rx:Discounts on prescription medications from 10-80% at 60,000+ locations nationwide