Credentialing & Licensing Manager

TeleMed2U•Austin, TX

About The Position

You will be responsible for all aspects of the credentialing and contracting. Responsible for ensuring providers are credentialed, appointed, and enrolled with health plans and managed care plans. Maintain up-to-date data for each provider in credentialing databases; ensure timely renewal of licenses and certifications. And all other credentialing and contracts duties as assigned.

Requirements

3-5 years of experience in licensing and credentialing preferred
Medicare and Medicaid experience preferred.

Nice To Haves

Certification/Licensure NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS) or actively pursuing certification is preferred.
Ability to investigate and analyze information and draw conclusions.
Excellent project management skills
Ability to communicate effectively, both orally and in writing.
Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.
Database management skills.
Knowledge of related accreditation and certification requirements.
Knowledge of medical credentialing and privileging procedures and standards.
Knowledge of medical staff policies, regulations, and bylaws and the legal environment within which they operate.

Responsibilities

Manages the TeleMed2U Provider Network’s credentialing process for all TeleMed2U clinical providers, in accordance with NCQA, URAC, Joint Commission, delegated contracts and CMS accreditation standards, Federal and State laws, and TeleMed2U’s policies.
Coordinates the management of the credentialing database, ensuring accuracy of data and reporting to partnering systems. Monitors critical data for extensive analysis and report generation.
Coordinates the management of TeleMed2U Provider Network’s credentialing applications, to ensure distribution, receipt, processing, and timely management through our credentialing process.
Coordinates the management of the expirables process to ensure all clinical provider licenses and certificates remain current, ensuring appropriate notification prior to expiration.
Monitors and reports turnaround times for processing of credentials applications, with continued focus on efficient and timely delivery of a high-quality product.
Manages Credentialing policies and procedures; develops, recommends, and/or implements changes, revisions, and enhancements as appropriate to current operating environment.
Provides consultations with regards to credentialing practices and services; prepares and conducts credentialing orientations and provides updates as appropriate on new policies and procedures.
Analyzes NCQA, URAC, delegation contracts, state laws and CMS standards and develops criteria to ensure compliance; revises general aspects of credentialing and privileging process as necessary; makes recommendations for and implements changes in policies and procedures.
When applicable, prepares for and coordinates credentialing audits in compliance with managed care delegated credentialing contracts and accreditation bodies.
Functions as primary TeleMed2U’s Provider Network credentials contact for all internal and external inquiries; develops and maintains positive working relationships.
Represents TeleMed2U’s Provider Network to internal and external customers as appropriate; makes presentations to and interacts with various internal and external customers on issues pertinent to area of specialty.
Maintains the TeleMed2U’s Provider Network. Keeps all necessary parties updated with changes to the Network provider list and field any inquiries regarding provider TeleMed2U’s Provider Network’s credentialing.
Ensure CAQH profiles are regularly updated for TeleMed2U’s Provider Network.
Prepare and submit spreadsheets to health insurance plans to ensure provider participation.
Ensure various databases are updated for proper tracking of enrollments and update requests.
Maintain necessary records of outstanding submissions and requests.
Update the company/third party databases with the physician/provider's ID number and start date.
Maintain familiarity and stay current with health insurance plans' procedures.
Coordinate all managed care credentialing activities to ensure provider participation status. Credentialing activities require substantial contact with outside agencies.
Maintain necessary logs, lists, records, and current documentation required for physician/provider credentialing and re-credentialing.
Verify physician/provider information for managed care plans including communication with health plan representative and other staff as necessary.
Follow-up with managed care companies to ensure expedient credentialing.
Remains current on policies affecting provider enrollment credentials & delegated clients/payers
Negotiates and executes new payor network contracts.
Maintains and monitors company payor and facility contracts.
Proactively facilitates renewal of existing company contracts with all clients (Payors, Health systems, clinics, etc.).
Collaborates with the billing supervisor to provide a proforma estimate on new payor contracts.
Manages the TeleMed2U Provider Network’s licensing process for all TeleMed2U clinical providers, in accordance with Federal and State laws, and TeleMed2U’s policies.
Coordinates the management of the licensing database, ensuring accuracy of data and reporting to partnering systems. Monitors critical data for extensive analysis and report generation.
Ensure appropriate communication occurs with physicians to successfully gather necessary information and forms for State Medical applications.
Monitors the expirables process to ensure all clinical provider licenses and certificates remain current, ensuring appropriate notification prior to expiration.
Monitors and reports turnaround times of Medical licensing approval across all 50 states.
Manages licensing procedures; develops, recommends, and/or implements changes, revisions, and enhancements as appropriate to current operating environment.
Tracks and reports on annual CME earned by the providers.