Manager of Credentialing
: Job Details :

The Manager of Credentialing oversees the operation of the Credentialing department to develop, manage and monitor processes and procedures that support credentialing, re-credentialing, and expirable data management. Oversees all of the credentialing functions including application management and primary/secondary source verification. Ensures compliance with the appropriate accrediting and regulatory agencies. Supervises credentialing staff in the day-to-day management of the overall credentialing process and database management. PRIMARY FUNCTIONS

Credential providers (medical/dental/behavioral health/optometry/podiatry/Ob/Gyn) and ensures consistent compliance with all payer contracts.

Coordinates the management of the credentialing database and associated modules, ensuring accuracy of data.

Monitors critical data for extensive analysis and report generation.

Coordinates the management of the electronic credentials application, to ensure distribution, receipt, processing, and timely delivery to health system entity.

Coordinates the management of the expirable process to ensure all clinical provider licenses and certificates remain current, ensuring appropriate notification prior to expiration.

Monitors and reports turnaround times for processing of credentials applications, with continued focus on delivery of a high-quality product, with the greatest efficiency, in the least amount of time.

Monitors the rules and regulations, and policies and procedures, ensuring compliance with accrediting organization requirements; participates in development and review of Credentialing policies and procedures; develops, recommends, and/or implements changes, revisions, and enhancements as appropriate to current operating environment.

Provides on-site consultations across True Health with regards to credentialing practices and services; prepares and conducts credentialing orientations and provides updates as appropriate on new policies and procedures.

Prepares for and coordinates credentialing audits in compliance with the managed care delegated credentialing contracts.

Functions as primary True Health credentials contact for all internal and external inquiries; develops and maintains positive working relationships.

Oversees the supervision of personnel, which includes work allocation, training, promotion, enforcement of internal procedures and controls, and problem resolution; evaluates performance and makes recommendations for personnel actions; motivates employees to achieve peak productivity and performance.

Represents True Health to internal and external customers as appropriate; makes presentations to and interacts with various internal and external customers on issues pertinent to area of specialty.

Performs miscellaneous job-related duties as assigned.

EDUCATION AND EXPERIENCE

College degree - Bachelor

AND 2 -5 years' experience in a credentialing position

KNOWLEDGE, SKILLS, AND ABILITIES

Computer Literate

Knowledge of principles of credentialing

Ability to make administrative/procedural decisions and judgments.

Ability to investigate and analyze information and draw conclusions.

Ability to develop and deliver presentations.

Ability to process computer data and to format and generate reports.

Ability to supervise and train employees, to include organizing, prioritizing, and scheduling work assignments.

Ability to communicate effectively, both orally and in writing.

Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.

Database management skills.

Knowledge of related accreditation and certification requirements.

Knowledge of medical credentialing and privileging procedures and standards.

RELATIONSHIP REPORTING

Reports to the Director of Revenue Cycle and Billing

PHYSICAL REQUIREMENTS

Able to sit for extended periods of time

Able to perform repetitive hand and wrist movements

Able to view a computer monitor for extended periods of time