Credentialing Manager

United Vein & Vascular Centers•Tampa, FL

About The Position

The Credentialing Manager role is responsible for onboarding employed physicians and for managing the credentialing process for all in-house contracted providers within the organization. Provides guidance regarding policies, procedures, and regulatory requirements. This role will be responsible for onboarding and insurance credentialing activities for all providers in accordance with internal policies, managed care guidelines, billing guidelines and other regulatory or accreditation agencies such as NCQA, AAAHC, CMS and CAQH.

Requirements

HS Diploma or GED required; Bachelor’s degree preferred.
5+ years’ credentialing experience required.
Previous experience with Medicaid enrollment, hospital privileging, and managed care.
Knowledge and understanding of the provider-IPA-payer relationship.
Experience with professional liability insurance applications.
Experience managing and leading direct reports.
Ability to maintain deadlines and multi-task.
Excellent written and verbal communication skills.
Extreme attention to detail and strong organization skills.
Must be able to demonstrate extreme confidentiality in the role.
Dependable; able to meet reliable attendance and punctuality standards.

Nice To Haves

Certified Provider Credentialing Specialist (CPCS) Certification preferred.

Responsibilities

Ensures all employed clinicians are onboarded to ensure they have all appropriate licensure and documents required for credentialing.
Ensures employed clinicians are privileged at the SNF and hospital facilities.
Ensures that all legal, licensure and accreditation standards are met.
Reviews the approval and termination of professional provider contracts as they relate to the credentialing process.
Ensures the accurate and timely information for the purposes of re- credentialing, data analysis and directory generation as well as recommending changes to the credentialing criteria and processes.
Monitors all governmental and private agency initiatives in the credentialing area.
Oversees all aspects of the physician and clinician licensing, including initial licensure, renewals, regulatory updates, and coordination with state medical boards to ensure uninterrupted practice eligibility.
Ensures all credentialing and re-credentialing policies and processes are in compliance with NCQA and all applicable state regulations.
Ensures credentialing activities are integrated within the appropriate QI committees and departments.
Hires, trains, coaches, counsels and evaluates performance of direct reports.
Acquires and maintains knowledge of the credentialing requirements of all national and state agencies, including National Committee for Quality Assurance (NCQA), URAC, or general accreditation.
Maintains a primary credentialing database reflecting all in-network providers and a database to track status of practitioner’s or facilities undergoing the direct credentialing or re-credentialing process.
Establishes individual files for each applicant containing the application, documents to support primary source verification and all other
Malpractice enrollment and maintenance for all providers.
Ensures completion of provider credentialing applications.
Contacts providers to request updates to licenses and documents; assist in renewals with expiration dates.
Follows up with insurance companies to ensure timely enrollment and re- enrollment for billing purposes.
Maintains multiple databases: online credentialing database (CAQH); provider information database, as well as all internal provider and insurance databases.
Assists in collection of data to perform credentialing, re-credentialing, and privileging.
Demonstrates and promotes a work culture committed to UVVC’s Core Values: understanding, nurturing, ingenuity, trust, excellence, and diversity.
Demonstrates behaviors that are consistent with UVVC’s Standards of Conduct as outlined in our Employee Handbook.
Maintains the confidentiality and security of Protected Health Information (PHI) in accordance with UVVC policies, the Health Insurance Portability and Accountability Act (HIPAA), and other applicable laws and regulations. PHI is a top priority of our organization.
Other related duties as assigned.