Manager - Credentialing

SKYGEN•United States,

23h•$85,284 - $127,926•Remote

About The Position

This is a fully remote opportunity where you will lead and support a credentialing team. The role requires you to serve as a subject matter expert in commercial credentialing, with strong experience in commercial insurance being essential. Proven leadership experience is also required, including developing teams and driving performance.

Requirements

2 year/Associate degree in Business or related field
3 - 5 years of experience in credentialing management capacity
Ability to organize and report on large amounts of data.
Ability to organize work appropriately to meet deadlines.
Ability to successfully lead teams.
Demonstrated ability to make appropriate decisions when faced with conflicting deadlines or needs.
Demonstrated use of Microsoft Office products (Word, Excel, PowerPoint).

Nice To Haves

2 year or 4 year degree in Business Administration or similar field
Experience with dental, commercial
Knowledge of Enterprise System

Responsibilities

Oversee the Credentialing department to ensure providers are credentialed in a timely and accurate manner.
Resolve complex issues and work with staff to provide feedback and training to ensure Credentialing processes are completed timely and accurately.
Develop and implement departmental procedures, quality measures, set goals and objectives to ensure effective and compliant workflow.
Foster an environment of continuous improvement through process and systematic efficiencies.
Work in conjunction with Human Resources to evaluate viable candidates for hire by identifying necessary skills and core competencies, developing relevant interview questions, and utilizing appropriate selection techniques.
Develop and motivate staff, initiating and communicating personnel actions including employment, terminations, performance reviews, salary reviews, disciplinary actions, and development plans.
Provide regular and behaviorally specific feedback to increase performance levels.
Oversee staff timecard and PTO requests to ensure timely and accurate reporting.
Develop and maintain standard procedures for the Credentialing department.
Assist in resolving complaints and issues for clients, providers, and internal staff.
Develop and maintain training documents to ensure accuracy and thoroughness.
Work effectively and collaboratively with peers and other internal resources in diagnosing and resolving issues.
Identify and report credentialing issues to appropriate departments and leadership.
Assist in the ongoing evaluation of policies and procedures and assist in development and implementation of new efficiencies based on assessments.
Work with Director of Provider Experience to identify, develop and implement best practices to ensure improved efficiency, cost effectiveness, and that contractual requirements are met and/or exceeded.
Serve as subject matter expert for credentialing requirements, including NCQA standards, federal and state regulatory guidelines, and accreditation-related expectations.
Provide leadership and guidance on credentialing policies, procedures, and operational practices to ensure alignment with NCQA, regulatory, and client requirements.
Monitor credentialing performance for large clients and drive corrective actions to address turnaround times, quality trends, and service concerns.
Identify opportunities to improve consistency, reporting, and operational performance across large client credentialing processes.
Act as an expert in area of credentialing and accreditation practices.
Ensure all departmental processes meet organization and industry standards to ensure provider network adequacy.
Provide regular reporting and status updates to clients as well as participate in client meetings to resolve questions and concerns as needed.
Comply with registering and creating your own id.me account or using your personal id.me account in which you have completed identity verification to access NPDB.