Job Responsibilities:
Provides leadership and management support including, but not limited to, the following:
Provide supervision and direction to Credentialing staff and credentialing team leads and SME's to meet
departmental objectives.
Sets and monitors production standards, key metrics and scorecards that are updated weekly
Develop, monitor, and continuously improve credentialing processes and reporting to ensure data integrity and
consistency with strategic corporate goals and objectives, while continuously evaluating current processes
looking for more efficient solutions.
Ensures 100% adoption of credentialing tools and software by staff.
Establish and maintains strict provider record retention processes to ensure team access to documentation
required to perform all duties.
Works with an offshore Audit and Training team to identify areas of focus for audit and enhance new hire and
active staff training.
Build relationships with key customers and work with internal credentialing team and customer to set project
priorities.
Build and establish relationships with state enrollment boards, credentialing agencies, and managed care
organizations.
Maintains knowledge of current health plans and agency requirements for licensing and credentialing providers.
Establish priorities daily, if needed, for staff to ensure that provider target start dates are met for new hires,
growth and recredentialing review and track requests to add new and remove terminated providers from the
group when necessary.
Participate in cross-functional project teams and attend Credentialing and other related meetings as necessary.
Problem is solved by conducting written and oral follow-up with group point of contacts, non-responsive
providers, verification organizations and/or appropriate departments, as needed, to assist with obtaining
credentialing packets and other documentation.
Maintains strict level of confidentiality on all matters pertaining to the provider.
Performance management and counseling of employees when needed, make recommendations, and participate
in corrective action, as needed.
In collaboration with the Director of MSO Delivery, we determine department staffing and hiring needs based on
current and prospective project demand.
Departmental responsibility for establishing staff time and record keeping procedures and serves to confirm
month end customer invoice accuracy and contract compliance.
Services, as needed, with members of the sales team or customer relationship management team to be a subject
matter expert and to participate in upselling opportunities where possi
Experience & Skills Necessary for Position:
Minimum 3 years of credentialing management experience
Strong knowledge of the healthcare payor environment, escalations, policies and guidelines.
Knowledge of credentialing and enrollment systems and processes
Knowledge of current CMS regulations
Demonstrated knowledge of provider licensing regulations.
Demonstrate an understanding of healthcare management, including staffing and leading
Strong, professional communications skills both written, verbal and presentation to effectively communicate
with all customer leadership and providers.
Commitment to excellence and high standard
Ability to prioritize and multi-task
Knowledge and proficiency with Microsoft Excel (pivot tables, macros), Word, Power Point and Outlook is
required
