Manage all provider credentialing and recredentialing.
Document related data management processes for PacificSource.
Collaborate with provider partners, internal customers, and other external constituents.
Supervise and provide guidance to assigned staff.
Participate in hiring process, train and evaluate team member performance.
Develop annual budgets and monitor spending.
Responsible for proactively working with other departments to improve interdepartmental processes.
Continually assess and improve Credentialing team processes.
Develop and implement systems and procedures to ensure program criteria compliance.
Maintain open communication with practitioners relating to required credentialing and survey processes.

Minimum of 5 years of health insurance experience with at least 3 years of credentialing experience required.
Experience managing teams in a health care environment strongly preferred.
Bachelor’s degree required.
Candidates with an associate’s degree and 2 years of relevant experience, or a high school diploma and 4 years of relevant experience, in addition to the required minimum years of work experience will also be considered.
Knowledge of healthcare delivery, NCQA and HIPAA are essential.
Ability to gain knowledge of PacificSource policies and procedures.
Attention to detail; ability to handle multiple tasks and prioritize effectively.
Must show initiative in approaching projects and day-to-day work.
Must be proficient in Word, Excel, Databases and credentialing software programs.

Credentialing Manager

Key skills