The Credentialing Manager oversees the management of the Credentialing Department by performing the following duties personally or through subordinate supervisors.
Responsibilities / Accountabilities :
Initiates proactive, creative problem-solving techniques for credentialing issues related to billing, claims denials, and communication to internal / external payer partners.
Establishes and implements strategic goals to align with department and corporate goals and objectives and conducts regular meetings with staff and assure that they are well informed of company goals and objectives, set priorities and discuss progress towards goals.
Ensures an excellent service experience for clinicians and payer partners throughout the credentialing process
Promotes professional growth through staff development and working with Senior Director in developing in-service training
Develops and maintains a strong working relationship with external payer partners and internal stakeholders
Partners with key stake-holders to address and / or resolve network provider status and / or issues with payers.
Partner with key stakeholders on provider / practice acquisitions to ensure that new provider loads are set up accurately and completed by the payers / plans.
Coordinates with quality in licenses for new and existing entities and locations.
Managing company's payer contracts including group agreements, licensing, individual provider contracts, credentialing with payers and works with internal departments to facilitate contracting, credentialing and licensing efforts for all networks / payers / organizations.
Gather, review all credentialing applications
Review of Contracts and Credentialing Documents.
Manage the Credentialing workflow and trackers
Manage day to day operations.
Other related duties may be assigned from time to time.
Qualifications and Requirements :
Preferably College Graduate (Degrees and Courses related to Medical Field is a plus)
Minimum of 3 years' experience at managerial level.
Experience in Healthcare is preferable
Healthcare experience related to clinician credentialing, licensing and contracting preferred.
Strong written and verbal communication skills.
Ability to work effectively with minimal supervision