Credentialing Manager

The Credentialing Manager plays an integral role within healthcare organizations, overseeing the process that allows medical professionals to practice at healthcare facilities or with insurance networks. This position involves managing the verification of qualifications, certifications, and licenses of healthcare providers to ensure they meet the necessary standards for providing care. By maintaining accurate and up-to-date records, the Credentialing Manager supports the seamless operation of healthcare services, ensuring that only qualified professionals are part of the team. This role requires a meticulous attention to detail and a strong understanding of regulatory compliance, as it serves to uphold the integrity and quality of healthcare delivery.

Job Responsibilities:

• Develop and implement policies and procedures for credentialing and recredentialing healthcare providers ensuring compliance with national accreditation standards, state and federal regulations, and payer requirements
• Develop and implement policies and procedures for the credentialing and recredentialing process, ensuring they meet industry standards and organizational needs
• Manage the primary source verification of education, training, board certification, work history, and licensure of healthcare providers
• Facilitate the resolution of discrepancies or concerns regarding applicants’ credentials, working closely with medical staff leadership and healthcare providers
• Liaise with external agencies, including insurance carriers and regulatory bodies, to ensure the timely sharing of credentialing information and compliance with external standards
• Manage the credentialing process from initial application through re-credentialing, including primary source verification, background checks, and review of licensure, certifications, education, and work history
• Responsible for integration of newly acquired entities, including software and staff
• Collaborate with internal departments, such as Human Resources, and Quality and Compliance to ensure alignment of credentialing processes with organizational goals and objectives
• Maintain accurate and up-to-date credential files and databases, ensuring confidentiality and security of sensitive information
• Serve as the primary point of contact for credentialing inquiries from healthcare providers, staff, and external stakeholders, providing timely and accurate responses
• Monitor and evaluate the performance of credentialing staff, providing guidance, training, and support as needed to ensure high-quality and efficient credentialing processes
• Stay informed about changes in credentialing requirements, regulations, and industry trends, and make recommendations for process improvements and enhancements
• Prepare and submit reports on credentialing activities, compliance metrics, and performance indicators to senior management and regulatory agencies as required
• Participate in audits, surveys, and accreditation reviews related to credentialing, providing documentation, and supporting evidence as needed
• Represent the organization in meetings, conferences, and industry events related to credentialing and provider enrollment
  
  

QUALIFICATIONS & EDUCATION REQUIREMENTS:

• Bachelor’s degree in either Healthcare Management, Business Administration, or other related field; Master's degree preferred
• Certification as a Certified Provider Credentialing Specialist (CPCS) or Certified Professional in Medical Services Management (CPMSM) preferred
• Minimum of 7 years' experience in healthcare credentialing, with at least 3 years in a leadership or supervisory role
• In-depth knowledge of credentialing principles, processes, and standards, including NCQA, Joint Commission, and CMS requirements
• Strong analytical skills with the ability to interpret complex regulations and accreditation standards
• Excellent communication and interpersonal skills, with the ability to interact effectively with healthcare providers, staff, and external stakeholders
• Demonstrated leadership abilities, including the ability to motivate and develop a team, foster a culture of accountability and continuous improvement, and achieve performance goals
• Proficiency in credentialing software and database management systems
• High level of integrity and discretion in handling confidential information
  
  

Health Connect America and its companies are a multi-state, community mental health, behavioral health, family preservation, and therapeutic foster care services provider(s). It is the mission of Health Connect America to create quality, affordable opportunities for individuals and families to achieve their greatest potential in a safe, positive living environment.

We encourage wellness for our staff by offering competitive compensation and benefits to our full-time team members including medical, vision/dental, 401K, Health Savings Account with company contribution, and paid time off. We also offer an Employee Assistance Program including 8 counseling sessions per year to promote emotional wellbeing.

Health Connect America and its companies are an Equal Opportunity Employer and considers applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics or any other basis forbidden under federal, state, or local law.

Powered by JazzHR

hApEsWma4V