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- Job Title
- Credentialing Manager
- Job ID
- Nashville, TN
- Other Location
The position is responsible for managing the credentialing team and ensuring an active credentialing status with all contracted payors for all Centers, Nurse Practitioners and employed physicians. The position is also responsible for ensuring that all licensure is updated and active for all of the markets and clinicians.
Additionally, this position serves as liaison between center staff, operations, billing and payers, answering questions about payer contracts, fee schedules, CMS issues, and maintaining all files.
· Responsible for documenting and tracking all credentialing, re-credentialing, provider enrollment, and hospital privileging activities within the Symplr IntelliCred software environment.
· Supervises, plans, directs, coordinates, and evaluates the work product of team members.
· Assists new providers with obtaining required clinical licenses, and coordinates the full cycle onboarding and enrollment into Medicaid, Medicare, and the commercial insurance plans.
· Establish policies, procedures, toolkits, and best practices necessary for successful provider onboarding, including established timeframes, required documentation, and checklists.
· Maintain and monitor all licenses and certifications in the Provider Trust database to ensure compliance within all markets.
· Coordination of provider enrollment activities (including initial enrollments or re-credentialing) for all Centers, employed physicians, and nurse practitioners.
· Ensure all facility and practitioner licenses and certifications are accurate and in good standing at all times including renewing facility license and permits.
· Complete all forms and supporting documents required to obtain hospital privileges for physicians, as necessary including renewal applications.
· Ensure that all processing and reporting deadlines are consistently achieved.
· Conducts weekly conference calls with the Clinical Operations teams to provide status updates of onboarding activities.
· Meets regularly with the Director of Managed Care Contracting and other team members to provide updates on progress and status of credentialing and enrollment matters.
· Participates in special projects, including acquisitions and de novo projects; opening new locations; adding new service lines, and closing facilities.
· Assists the Revenue Cycle Team with claims denial research; finding out whether we are in-network with specific products, and other miscellaneous billing and collections issues.
· Assists the Director of Managed Care with special contracts projects, including the loading of executed contracts into the iContracts database.
· Performs any other functions as required by management.
· Regular attendance and punctuality is required.
Qualifications and Education Requirements
· At least five (5) years of experience of credentialing experience in a managed care or provider setting, including experience using a credentialing database.
· Demonstrated personnel leadership (remote and onsite), provider enrollment technical expertise, effective and professional communication, disciplined execution of strategic initiatives, and relationship management.
· Specific knowledge of the payer environment and payer issues, particularly billing and collections.
· Strong knowledge of the rules/regulations of Medicare/Medicaid and other government payors, as well as commercial insurers and specialty contracts to ensure accurate and timely billing and payment of claims.
· Ability to work a flexible schedule (including overtime, and weekends), as necessary.
· Excellent customer service and communication skills.
· Ability to work independently and as part of a team.
· Working experience with Excel spreadsheets and Microsoft Word documents.
· College degree or commensurate working experience in healthcare.
· Knowledge of basic medical terminology.
· Credentialing database experience (such as IntelliCred, E-Vips, Vistar, Cactus, Symed, etc.)
Strong Business and Organizational Competence. Exceptional Customer Service Skills. Strong functional Competence. Interpersonal Skill Competency. Stress Tolerance. Initiative. Adaptability. Accountability. Integrity. Self-Confidence. Time Management Skills with an emphasis on multi-tasking.
Physical Demands and work environment
The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Physical demands: Required job duties are essentially sedentary in nature, consisting of occasional walking, standing, lifting and/or carrying ten pounds maximum, seeing, speaking and hearing.
Work environment: Required job duties are normally performed in a climate-controlled office environment.