Credentialing Manager

Solomon Page Group
Full time
Other
United States
Hiring from: Anywhere

Remote Credentialing Manager


Job Description


Responsible for overseeing the credentialing department and ensuring the proper and timely administration of the credentialing process and provider enrollment with all health and managed care plans.


Responsibilities:



  • Develops and revises forms, policies and procedures as they relate to the Credentialing department.

  • Maintains computerized credentials database. Enter data, prepare forms and reports, and keep data current.

  • Maintains current knowledge of NCQA and state specific credentialing standards as well as standards imposed by other regulatory or certification entities appropriate to the organization.

  • Requests renewals of licenses, DEA & DPS Certificates, malpractice coverage documentation as well as any other documentation required to keep files current.

  • Oversees records and reports provider changes and terminations.

  • Monitors and processes initial and re-credentialing to maintain compliance with timelines as required.

  • Prepares and sends requests for verifications obtain verifications, review for accuracy and completeness.

  • Responsible for preparation and submission of forms and reports for provider enrollment in managed care plans. Perform follow-up to ensure that providers are loaded within a reasonable length of time. Keep managed care plan enrollment data current in database.

  • Answers general information questions in regard to all aspects of the Credentialing Department.

  • Runs special reports when needed.

  • Assists with special projects as needed.

  • Attends meetings as required.

  • Maintain strict confidentiality.

  • Other duties as assigned.


Qualifications:



  • Bachelor’s degree.

  • CPCS certification a plus.

  • 5+ years’ experience in credentialing.

  • Ability to multi-task in a fast-paced environment.

  • Ability to meet tight deadlines consistently and work well under pressure.

  • Excellent verbal and written communication skills.

  • Ability to communicate with internal and external customers.


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