Manager, Credentialing

Altais

2d•$62,250 - $80,000

About The Position

Are you looking to join a fast-growing, dynamic team? We’re a collaborative, purpose-driven group that’s passionate about transforming healthcare from the inside out. At Altais, we support one another, adapt quickly, and work with integrity as we build a better experience for physicians and their patients. This role is responsible for the direct supervision of day-to-day operations of the credentialing function to support the delegated function for all our Health Plan Partners, supporting credentialing efforts for all lines of business. This role manages the credentialing program for Altais affiliated entities, including BTP employed clinicians, vendors providing clinical services on the MSOs behalf, as well as MSO services for any other medical group or IPA purchasing from Altais Health Solution. This role is also responsible for the administrative aspects for all credentialing functions needed to meet medical group, health plan and National Committee for Quality Assurance (NCQA) requirements. This role, in combination with the rest of the Credentialing team is to maintain, develop and implement credentialing processes, procedures and processes in line with all regulation and compliance requirements. Additionally, this role will oversee the interdependencies between departments, consistently maintaining knowledge and understanding of the impact to providers and how that may affect the Credentialing team moving forward.

Requirements

Bachelor’s degree or equivalent to 4 year university degree, preferably in healthcare related field of study.
5+ years professional experience working in credentialing, preferably in a managed care setting required.
Must be eligible to take National Association Medical Staff Services (NAMSS), Certified Provider Credentialing Specialist exam within 18 months of employment

Nice To Haves

NAMSS Credentialing certification preferred.

Responsibilities

Providing leadership / coaching to the credentialing team staff, ensuring function initiatives and deliverables are complete and accurate in a timely manner
Responsible for processing credentialing applications accurately and promptly in accordance with Credentialing policies and procedures and in full compliance with all regulations
Manages audit preparation of materials and files necessary to comply with external audits by payors and/or governmental agencies
Manages relationships with health plan delegation oversight committee members.
Manages process for initial and re-credentialing review by Clinical Advisory Group for exception physicians
Manages claims and appeals and peer review physician documentation for Clinical Advisory Group
Conduct audits of the credentialing database, confirming accurate input of provider data, and verifying accuracy of modifications made to the database
Owns end to end delegated credentialing process
Develops functional, market level, and/or site strategy, plans, production and/or organizational priorities for Altais Health affiliated groups as well as clients purchasing MSO services.
Identifies and resolves technical, operational and organization problems outside own team
Serves as SME for business requirements for sPayer