Credentialing Manager
Salary undisclosed
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Brief Description
SENTA is seeking a highly motivated and experienced Credentialing Manager to join our team. The Credentialing Manager will be responsible for managing the credentialing process for all healthcare providers within our organization, ensuring compliance with regulatory and accrediting agency requirements.
EDUCATION AND EXPERIENCE
SENTA is seeking a highly motivated and experienced Credentialing Manager to join our team. The Credentialing Manager will be responsible for managing the credentialing process for all healthcare providers within our organization, ensuring compliance with regulatory and accrediting agency requirements.
- Develops and maintains credentialing/re-credentialing processes to continually increase the efficiency and efficacy of credentialing for internal and external stakeholders.
- Reviews existing, develops new and maintains Credentialing Policies and Procedures, desktop policies and advises on the development of critical corporate guidelines and best practices.
- Supervises Credentialing Specialists, monitors their performance, identifies and addresses performance improvement opportunities.
- Manages credentialing submissions with expediency and accuracy with efficient internal and external communication throughout the process.
- Communicates and works to improve interdepartmental relationships with Credentialing, Recruitment, Human Resources, Revenue/Billing, Legal/Compliance, and other designated departments.
- Researches and analyzes issues, ensures appropriate documentation to identify outcomes and accurately interprets internal and external guidelines and policies.
- Develops, implements, and manages processes to create, update and maintain practitioner files for enrollment purposes and for ensuring accurate and timely completion of credentialing and practitioner enrollment.
- Prepare management and operational reports for internal and external customers.
- Maintains current Credentialing database up to date.
- Completes ongoing file review on an intermittent basis to identify objectives, error rates, timeliness and use data as an opportunity to counsel staff, as appropriate.
- Establishes and maintains production and quality metrics for Credentialing Specialist(s).
- Facilitates problem solving of operational and revenue cycle issues through collaboration with client health plans and internal stakeholders.
- Manages multiple projects simultaneously and under tight deadlines.
- Assists with resolution of contract and claim issues related to practitioner enrollment and identifies and communicates opportunities for process improvement.
- Responds to inquiries regarding practitioner credentialing and enrollment.
- Maintains confidentiality of all credentialing information in compliance with federal and state statutes, as well as SENTA policies.
- Perform other job duties as assigned.
EDUCATION AND EXPERIENCE
- Bachelor’s Degree in Business, Healthcare or related field preferred OR
- Associates Degree and appropriate combination of education and experience.
- Experience with MD-Staff or similar practitioner credentialing, data collection and record management system.
- Minimum of two years progressive management experience required.
- Two years of relevant credentialing experience required.
- Credentialing experience with state scope of practice and licensing requirements preferred.
- Office environment
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