Manager - Credentialing

Important Things to Know

This is a fully remote opportunity, offering flexibility to lead and support a credentialing team from anywhere.

Responsibilities

• Oversee the Credentialing department to ensure providers are credentialed in a timely and accurate manner.
• Resolve complex issues and work with staff to provide feedback and training to ensure Credentialing processes are completed timely and accurately.
• Develop and implement departmental procedures, quality measures, set goals and objectives to ensure effective and compliant workflow.
• Foster an environment of continuous improvement through process and systematic efficiencies.
• Work in conjunction with Human Resources to evaluate viable candidates under consideration for hire by identifying necessary skills and core competencies for various roles, developing relevant interview questions to assess candidate knowledge, skill, and position fit with future growth and business objectives, and utilizing appropriate selection techniques.
• Develop, motivate staff, initiate and communicate a variety of personnel actions including employment, terminations, performance reviews, salary reviews, disciplinary actions, and development plans. Provide regular and behaviorally specific feedback to increase performance levels.
• Oversee staff timecard and PTO requests to ensure timely and accurate reporting.
• Develop and maintain standard procedures for the Credentialing department.
• Assist in resolving complaints and issues for clients, providers, and internal staff.
• Develop and maintain training documents to ensure accuracy and thoroughness.
• Works effectively and collaboratively with peers and other internal resources in diagnosing and resolving issues.
• Identify and report credentialing issues to appropriate departments and leadership.
• Afford assistance in the ongoing evaluation of policies and procedures and assist in development and implementation of new efficiencies based on assessments.
• Work with Director of Provider Experience to identify, develop and implement best practices to ensure improved efficiency, cost effectiveness, and that contractual requirements are met and/or exceeded.
• Serve as subject matter expert for credentialing requirements, including NCQA standards, federal and state regulatory guidelines, and accreditation-related expectations.
• Provide leadership and guidance on credentialing policies, procedures, and operational practices to ensure alignment with NCQA, regulatory, and client requirements.
• Maintain monitoring of credentialing performance for large clients and drive corrective actions to address turnaround times, quality trends, and service concerns.
• Identify opportunities to improve consistency, reporting, and operational performance across large client credentialing processes.
• Ensure all departmental processes meet organization and industry standards to ensure provider network adequacy.
• Provide regular reporting and status updates to clients as well as participate in client meetings to resolve questions and concerns as needed.
• Must comply with registering and creating your own id.me account or using your personal id.me account in which you have completed identity verification (uploading a copy of government issued id, SSN and picture or video scan) to access NPDB.

Qualifications

Required

• 2 year/Associate degree in Business or related field
• 3 - 5 years of experience in credentialing management capacity
• Ability to organize and report on large amounts of data
• Ability to organize work appropriately to meet deadlines
• Demonstrated ability to make appropriate decisions when faced with conflicting deadlines or needs
• Demonstrated use of Microsoft Office products (Word, Excel, PowerPoint)

PREFERRED

• 2 year or 4 year degree in Business Administration or similar field
• Experience with dental, commercial
• Knowledge of Enterprise System

Benefits

The salary range and midpoint is listed below for your reference. Please keep in mind that your education and experience along with your knowledge, skills and abilities are taken into consideration when determining placement within the range.

Compensation Range: $85,284 - $127,926
Compensation Midpoint: $106,605