Avēsis · 6 hours ago

Credentialing Manager

United States

Full-time

Remote

Mid, Senior Level

$74K/yr - $116K/yr

5+ years exp

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Responsibilities

Lead a first-class, metrics-driven credentialing operation maintaining compliant operations while achieving best-in-class turnaround times.

Provide leadership, mentoring, training, and coaching to all Credentialing team members.

Serve as a point of contact for internal and external clients as it relates to credentialing requirements, and credentialing needs.

Maintain a comprehensive understanding of healthcare credentialing requirements.

Implements department goals and continuous process improvement initiatives.

Coordinate audits of Credentialing documents/processes.

Implements performance management strategies as needed to optimize team member contributions.

Facilitate Credentialing Committee and governance.

Actively participate in the maintenance of the provider database(s) by receiving and communicating changes to appropriate parties and performing the changes within the system when necessary. Routinely monitors database(s) to assure accuracy (report changes to the appropriate data entry sources).

Lead our delegated credentialing program, including program development, monitoring, and audits.

Establish collaborative working relationships that support cross-functional relationships and accomplishments.

Qualification

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Credentialing ManagementNCQA StandardsProvider Data ManagementCredentialing SoftwarePrimary Source VerificationMicrosoft ExcelCAQHOIG ComplianceNPDB KnowledgeTeam DevelopmentFlexibleCPCS Certification

Required

Bachelor’s Degree in Business, Health Care related field or industry experience.

5+ years of experience in supervisory or management level experience in credentialing.

Intermediate level use of Microsoft Excel.

3+ years of experience working with credentialing software.

5+ years of experience managing and maintaining provider network databases.

Working knowledge of NCQA standards and payer credentialing standards required.

Working knowledge of best practices for provider data management and maintenance.

Knowledge of PSV (primary source verifications), CAQH, OIG (Office of Inspector General) & NPDB (National Practitioner Data Bank).

Strong computer, data entry and analysis skills required.

As this role is a remote role, you are required to maintain internet service that allows you to complete your essential job duties without issue. Rates of 50 Mbps download and 25 Mbps upload while hardwired and not on a VPN are sufficient.