Credentialing Manager

RadNet • Indianapolis, IN

11d

About The Position

Artificial Intelligence; Advanced Technology; The very best in patient care. With decades of expertise, RadNet is Leading Radiology Forward. With dynamic cross-training and advancement opportunities in a team-focused environment, the core of RadNet’s success is its people with the commitment to a better healthcare experience. When you join RadNet as Indiana Credentialing Manager, you will be joining a dedicated team of professionals who deliver quality, value, and access in the 21st century and align all stakeholders- patients, providers, payors, and regulators achieve the best clinical outcomes.
JOB SUMMARY
The Indiana Credentialing Manager is responsible for all aspects of the credentialing, re-credentialing and privileging processes for all medical providers who provide care at RadNet Indiana and all Eastern locations. The manager will be primarily responsible for all IN imaging center credentialing and payer enrollments and will help with other for RadNet owned and operated facilities as necessary. This position will lead the Indiana Credentialing Team. The position is responsible for working with leadership in each local RadNet market, IN, NY, NJ, DE, MD and FL, including the SVP/VPs of Clinical Operations for each market, Directors of Contracting, Directors of Insurance Verification Teams (IVT), Directors of Patient Service Representatives (PSRs), Directors of Clinical Operations, Charge Capture, AR Management and Data Integrity leadership teams. This position has a key role in insurance payor relationships at senior levels, driving reimbursement and revenue cycle management efficiencies through compliant credentialing in uniquely designed radiology physician groups, hospitals and health systems and joint venture environments. The position will follow the latest regulatory and medical policies and procedures, processes and systems in place to support the most efficient credentialing, resulting in maximizing reimbursement and provider and patient satisfaction.

Requirements

• At least seven years of experience in health care credentialing, insurance verification, appeals negotiations and processing in the health care industry, health care billing/claims processing, and data processing and software operations in the health care industry.
• Exceptions to years of experience above, may be made given extensive industry related experience of at least 5 years radiology credentialing and progressive team management experience.
• Requires a comprehensive understanding Commercial health plans, Medicare and Medicaid health plans.
• Extensive knowledge of medical coding, CPT and HCPCS codes and ICD 10, direct radiology coding knowledge preferred.
• Comprehensive understanding of medical management and health insurance concepts, information management systems and strong analytical and problem-solving skills are required.
• Bachelor’s degree in healthcare administration highly preferred.
• Strong Excel data analysis skills and proficiency with Microsoft Office applications.
• Strong written, verbal and interpersonal communication skills.

Nice To Haves

• Communicates, cooperates, and consistently functions professionally and harmoniously with all levels of supervision, co-workers, patients, visitors, and vendors.
• Demonstrates initiative, personal awareness, professionalism and integrity, and exercises confidentiality in all areas of performance.
• Follows all local, state and federal laws concerning employment to include but not limited to: I-9, Harassment, EEOC, Civil rights and ADA.
• Follows OSHA regulations, RadNet and site protocols, policies and procedures.
• Follows HIPAA, compliance, privacy, safety and confidentiality standards at all times.

Responsibilities

• Responsible for ensuring providers are credentialed, appointed, and privileged with health plans, hospitals and patient care facilities.
• Ensure that the personnel/providers of a RadNet facility, or RadNet affiliated professional corporation (PC) are properly trained, licensed and certified as mandated by state and federal regulations. In addition, ensure that all services offered by these facilities and providers meet standards set by state and federal government agencies.
• Ensures continued high levels of performance with regulatory, accreditation, and internal requirements including but not limited to CAQH, NCQA, DOI, Medicaid, CMS.
• Provides leadership and oversight of development, documentation and implementation of a IN accreditation plan that includes auditing, coordination of multiple required program processes, such as education and training.
• Lead, manage and ensure that all credentialing specialists review applications, verify both individual and facility accreditation, maintain records of verification and work with auditors as needed.
• Ensure the resolution of Claim Holds, Clearinghouse rejections and denials related to credentialing & provider enrolment issues in a timely manner to avoid delays and loss revenue.
• Maintains copies of all current licenses, DEA certificates, malpractice coverage and any other required documents for all providers.
• Maintains Verity and ECHO OAP databases in which new information or update existing information regarding employee training, licenses, education, continuing education and relevant job experience.
• Ensure that all necessary licenses and credentials are verified and updated for the healthcare facility in which they work. This might include conducting background checks, contacting licensing boards, reviewing license applications, obtaining education information and interviewing references.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 5,001-10,000 employees