Credentialing Manager

Role Overview

• Coordinate policies and procedures related to the member affiliate provider credentialing and payer enrollment process.
• Manage the internal credentialing database, ensuring accuracy of data and ability to assess database and utilize reporting.
• Coordinate the management of expirable to ensure all provider licenses and certificates remain current and ensure appropriate notification prior to expiration is provided to all providers.
• Monitor and report turnaround times for processing of payer enrollment applications.
• Coordinate the maintenance and enhancements of the credentialing database.
• Facilitate the credentialing reporting requirements.
• Ensure the team is obtaining, updating, and maintaining the National Plan and Provider Enumeration System (NPPES) / Provider Enrollment, Chain and Ownership System (PECOS) accounts for all APRNs, PAs and physicians.
• Facilitate the maintenance of electronic copies of current state licenses, Board certification, DEA registration and CSR (LA only) certificates, malpractice coverage and any other required credentialing documents for all providers.
• Prepares for and coordinates credentialing audits when needed.
• Oversee the Credentialing Specialist position, which includes work allocation, training, enforcement of internal policies and procedures, problem resolution, holds staff accountable, performance, and problem resolution.
• Interacts with various customers on issues related to credentialing via email and meetings.
• Upholds organizational values and standards, while proactively seeking ways to improve efficiency, equity, and service excellence.
• Ensure compliance with all CHN and affiliate policies, as well as all state and federal regulations.
• Provides positive and development feedback and accountability related to all practices.
• Demonstrates commitment to CHN and Planned Parenthood’s health equity mission, with emphasis on racial equity and community accountability. Demonstrates dedication to learning about racial equity and addressing structural racism in healthcare.
• Consistently delivers high-quality results using sound judgment and data-driven decisions. Prioritizes customer needs by providing prompt, accurate service to all stakeholders.

Requirements

• Bachelor’s degree and three (3) years of related experience with credentialing providers in a medical practice, with the accompanying knowledge and understanding of the credentialing process with health insurance plans and use of CAQH, or the equivalent combination of education, training, and related experience.
• Customer focus and adaptability to different personality types
• Ability to multi-task, set priorities, and manage time effectively.
• Strong analytical and problem-solving abilities
• Proficiency with Microsoft software (Excel, etc.)
• Must be able to create and edit fillable forms in Adobe Acrobat
• Ability to handle highly confidential and sensitive matters and documents.
• Ability to define problems, collect data, establish facts and draw valid conclusions.
• Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
• Knowledge of business practices and protocols
• Ability to demonstrate initiative and to work with minimal direction.
• Demonstrated ability to maintain a customer-centric service approach in a fast-paced environment.
• Excellent written and verbal communication skills and ability to collaborate and interact with all levels within and outside of CHN if necessary.
• Strong attention to detail and follow-up; and ability to multi-task in fast-paced environment
• Demonstrated dedication to Planned Parenthood’s mission, vision, and values.
• Strong interpersonal skills and the ability to build relationships with stakeholders.
• Excellent time management, and problem-solving skills

Benefits

• Health Care Coverage (Medical, Dental, & Vision); eligibility for full-time, regular employees on date of hire
• Flexible Spending Accounts and Health Savings Account
• Short-Term Disability and Basic Life & AD&D Insurance provided by CHN
• Voluntary elections for Long Term Disability and Additional Life & AD&D Insurance available at cost
• Employee Assistance Program
• Retirement Plan, 3% employer match after one year of service
• Paid Time Off Program includes accrual-based PTO, Health Time Off (HTO), and nine (9) paid Holidays