Experienced Credentialing Manager

We are looking for a Credentialing Specialist to assist in further growth across the US!

*Required* Experience credentialing specialties and surgeons!

Position Summary

This position will ensure that medical staff members' maintain current credentials and licenses to work legally in their field or specialty. They will also monitor upcoming renewal dates and work with medical staff to advise them of the required steps to maintain their credentials.

Essential Duties & Responsibilities

• Oversees, compiles, and maintains current and accurate data for all providers including CAQH, NPPES and PECOS.
• Oversees and maintains PECOS for practice. Processes all applications, reassignment of benefits, etc.
• Oversees and maintains TMHP for practice.
• Oversees and completes provider initial credentialing and re-credentialing applications for insurance participation (both GROUP DIRECT contracts and delegated contract), facility privileges, other; monitors applications and follows-up as needed.
• Oversee and completes initial application for mal-practice at onboarding for new providers. Ensures renewals and/or departures are updated or removed from policy.
• Maintain copies of current state licenses, DEA certificates, malpractice coverage, and any other required credentialing documents for all providers. Sends reminder notices at 60 and 30 days. Track and ensure all completed within deadline.
• Maintain corporate provider contract files.
• Maintains knowledge of current health plans and agency requirements for credentialing providers.
• Ensures practice addresses are current with health plans, agencies, and other entities. Updates as needed.
• Updates Clinic Managers of provider participation with insurance plans once approved.
• Prepares and responds to insurance’s requests for additional information.
• Timely responses to inquiries.
• Must maintain confidentiality of all credentialing processes.
• Manage multiple projects simultaneously and under tight deadlines.
• Identify and communicate all concerns regarding provider credentialing and enrollment, including excessive timeframes for outstanding applications to the designated departments.
• Any other duties as assigned by management

Qualifications

EDUCATION AND EXPERIENCE

• High school graduate or equivalent
• Knowledge of general clerical and office procedures
• Strong work ethic, attention to detail, regular attendance
• Must be self-directed and able to work independently
• Attention to detail a must

• Professional, calm and courteous demeanor
• Excellent verbal and written communication skills

COMPUTER SKILLS

• Proficient computer skills in Microsoft Office including Outlook, Excel and Word

• Organization — Uses time efficiently by prioritizing and planning work activities; is methodical and efficient in structuring tasks to be accomplished.
• Professional Maturity — The ability to separate feelings from the real issues at hand. The ability to legitimately and objectively challenge the substance of our beliefs and biases of our observations.

• Time Management — Managing one's own time and the time of others; the ability to shift back and forth between two or more activities or sources of information (such as speech, sounds, touch, or other sources).
• Active Listening — Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.

• Interpersonal Communication — Writes and speaks effectively based on the psychological, relational, situation, environmental and cultural dynamics within the situation
• Communication — The ability to write and speak effectively using appropriate convention based on the situation; actively listens to others, asks questions to verify understanding, and uses tact and consideration when delivering feedback to others.

Physical Demands

• Physical Activity Level: Sedentary physical activity performing non-strenuous daily activities of an administrative nature
• Physical Demands: Exerting up to 10 pounds of force occasionally to lift, carry, pull, or otherwise move objects; Substantial movements (motion) of the wrist, hands, and/or fingers in a repetitive manner

Work Environment

Well-lighted, heated and/or air-conditioned indoor office setting with adequate ventilation; Moderate noise (examples: business office with computers and printers, light traffic), daily stair climbing; Typical schedule is Monday through Friday with regular working hours; Occasional overtime may be required. Time Off requests at end of month should be avoided and will be reviewed on a case by case request.

Charge Audit Corrections Log Example (Will be Built in Excel with Drop Downs for clinic and Standard Corrections reasons

Audit Date

Date of Service

Clinic

Audit Correction