Job description

The Manager, Provider Credentialing and Network Management will oversee the daily operations of credentialing and provider relations. In addition, the manager will ensure compliance with client credentialing requirements, delegation agreements and NCQA requirements. You will also be responsible for designing and implementing processes and procedures that support our growing business.

Responsibilities:

• Own the credentialing, network monitoring, and re-credentialing processes.
• Review the source document/application for complete and accurate information
• Interface with practitioners, office managers, etc. regarding questions or issues with source document information/application`
• Work with clinical providers and our third-party vendor to complete, submit, and track all provider credentialing and licensing applications
• Manage third party Credentialing Verifications Organization (CVO) vendor to complete credentialing files timely and accurately
• Familiar with verifications such as NPDB verifications, OIG/SAM Exclusions, SSDMF, NPI, Opt Outs, etc.
• Assists providers in completing all required registrations for enrollment with Medicare (PECOS) and Medicaid.
• The position is responsible for the review and processing of provider applications for submission to the Credentialing Committee for approval.
• Manage all Credentialing Committee operations under partnership with our Sr. VP, Operations
• Ensure timely renewals on licenses and certifications and coordinate follow up if needed to obtain outstanding items
• Communicates approval of credentialing, training and onboarding of new providers.
• Coordinate orientations and systems trainings, as applicable
• Responsible for maintaining the integrity of provider data in the credentialing database.
• Responsible for Provider Communications, processing and coordinating with HR on bi-weekly payments, and tracking
• Maintain regular reports and communications with company management, providers, and employees regarding network participation status and credentialing/contracting decisions
• Audit and preserve credentials files and records according to our policy and procedures
• Maintains current electronic forms, policies and procedures to be in compliance with accrediting and regulatory bodies
• Possess excellent organization and time management skills to complete job responsibilities and duties as directed.
• Ability to work in a demanding situation, changing focus of work due to changing priorities

Required Skills and Experience:

· Minimum 3 years’ experience in a Credentials Verification Office, Medical Staff Services Office, or medical practice setting

· Ability to work cross functionally and interface with all levels of the organization.

· Excel as an individual contributor but also works well in a collaborative and team environment

· Experience managing a remote staff as well as in office staff.

· Experience creating and delivering presentations to internal and external teams.

· Proficient with Microsoft Office suite, such as Word, Excel, and Powerpoint.

Pluses:

· CPCS Certification

Knowledge of legal, regulatory and accreditation credentialing requirements preferred

Job Type: Full-time

Schedule:

• Monday to Friday

Experience:

• 3 years’ experience in a Credentials Verification Office: 3 years (Preferred)

Work Location: Remote

offroadmanagementgroup.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, offroadmanagementgroup.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, offroadmanagementgroup.com is the ideal place to find your next job.