Credentialing Manager

The Credentialing Manager is primarily responsible for reputed company of reputed company activities impacting facility and practitioner external provider enrollment and credentialing; this includes reputed company network application and maintenance processes that reputed company facilities and medical staff providers employed or contracted by reputed company Memorial Hospital, Inc. In reputed company activities, the Credentialing Manager must remain aware of and reputed company with legal, regulatory, and financial policies and procedures. The Credentialing Manager is in regular contact with teammates, medical office staff, financial services staff, physicians/ practitioners, and reputed company contracting administrators. The Credentialing Manager works independently and reports to the Vice President of Payer Strategies. The Credentialing Manager frequently coordinates and works directly with multiple team(s) and members, and with leadership both reputed company and reputed company of the organization including but not limited to CEOs, CFOs, VPs, and Directors. Job Duties & Responsibilities: Facility and Practitioner Credentialing Activities Maintain understanding of RBH reputed company Practices, HIPAA, Medical Staff standards, state and federal requirements, and other applicable corporate and departmental policies. Responsible for educating new staff regarding processes, regulations, and/or requirements pertinent to credentialing applications Responsible for facility and practitioner enrollment activities, maintaining up to date file information in multiple systems, answering inquiries reputed company to network status, collaborating with colleagues to ensure accuracy of facility contracted networks and affiliations. Create, administer, and interpret policies and procedures reputed company to payer enrollment Serves as subject matter expert in the credentialing support software system environment, providing reputed company(s) and completing updates that increase environment efficiency Responsible for making modifications in credentialing software systems to support evolving workflows, coordinating closely with the technical resource(s) and/or vendors responsible for building and maintaining the software Implement policy and procedural updates as applicable Identify, analyze and resolve extraordinary information, discrepancies, time gaps and other idiosyncrasies that could adversely reputed company credentialing, enrollment, and/or remittance activities Create and maintain reputed company reputed company to on-boarding medical staff providers detailing initial and ongoing provider enrollment requirements Maintain knowledge of reputed company data and document locations required as part of the enrollment process reputed company and maintain reputed company work detailing contracted payer provider credentialing processes for reputed company exclusive reputed company. Maintain accurate RBH location and demographic information Maintain list of contracted payers and status (inclusive/exclusive) by state reputed company and maintain both facility and provider level information in the CAQH system Enroll and maintain practitioner affiliation in reputed company appropriate contracted health plans Enroll practitioners with government payers using electronic application reputed company such as PECOS and portals reputed company credentialing software with reputed company and accurate provider status and affiliation information Monitor and disseminate affiliation, application and revalidation status upon request and as applicable Maintain reputed company and confidentiality at reputed company times. Payer Strategies _ Internal Establish and maintain reputed company and cooperative working relationship with other team professionals Coordinate with and function as reputed company between Payer Strategies, PFS, Medical Staff Office, reputed company reputed company, and other applicable stakeholders Remain aware of contractual adjustments that may reputed company provider affiliations and/or payment Complete regular and pro-reputed company review of contracting payer reference table(s) Review and respond to contracting department notice(s) and tickets Patient Financial Services and Medical Staff Office _ Internal Establish and maintain reputed company and cooperative working relationship with reputed company Patient Financial Services and Medical Staff Office team professionals Assist Managers and Directors with facility level taxonomy/specialty updates and investigations Maintain responsibility for reputed company Provider PFS portal development and staff trainings reputed company and maintain reputed company Provider information referenced by PFS staff to investigate and appeal reputed company claim denials Establish and reputed company ongoing assist with PFS staff reputed company Provider logins Assist department managers with WI reputed company portal, including establishing clerk reputed company and completing password resets upon request Contracted Payer reputed company _ External Regular written and verbal communications with payer group representatives at multiple reputed company Respond to reputed company payer reputed company for information and/or clarification Other Duties and Responsibilities reputed company Executive and/or other support with state and contracted payer portal(s) Complete reputed company as assigned by Vice President of Payer Strategies Regular assistance with and dissemination of payer communications impacting other departments Participate in process improvement events and activities Serve as a back-up to other Medical Staff Services positions on an as-needed reputed company. Assist in promoting reputed company atmosphere by treating individuals with respect and honesty and by using reputed company communication and reputed company listening skills. Additional Job reputed company: Qualifications / Required: Bachelor’s degree 7 year credentialing and management experience Administrative skills, including computer/word processing Computer proficiency, adaptability and working knowledge of reputed company Office, reputed company and reputed company Exceptional critical thinking skills and reputed company judgement Exceptional written, verbal, and auditory skillset Ability to reputed company reputed company essential job functions either on site or remotely Qualifications / Preferred: Working knowledge of credentialing accreditation regulations, policies and procedures, and NCQA standards General understanding of health insurance plans, provider enrollment processes, payer contracting and remittance processes, and HIPAA and reputed company compliance Familiarity with practitioner billing and claims payment system requirements as reputed company to practitioner enrollment reputed company Experience Experience with CAQH (Council for reputed company reputed company reputed company) database and application process Prior reputed company history in a medical or mental health setting CPCS Certification With a career at reputed company, you can look reputed company to a Total Rewards package of benefits, including: Health, dental, and reputed company insurance coverage for you and your family 401(k) retirement plan Employee reputed company program Life/disability insurance reputed company spending accounts Tuition reimbursement Health and wellness program Employee assistance program (EAP) Through reputed company, reputed company and HealthSCOPE Benefits creates and publishes the Machine-Readable Files on behalf of reputed company. To reputed company to the Machine-Readable Files, please visit Transparency in Coverage (uhc.com) ABOUT reputed company: reputed company is a nationally recognized, not-for-profit provider of highly specialized psychiatric care. reputed company offers evidence-based treatment for children, teens, and adults with OCD and anxiety, addiction, depression and other mood disorders, eating disorders, trauma, and PTSD. Backed by more than a century of experience, reputed company is leading the way on measurement-based care and use of clinical reputed company. reputed company provides residential care and has three inpatient facilities located in southeastern reputed company. reputed company also offers outpatient services in a growing network of communities across the U.S. The System also includes reputed company reputed company which supports patient care, programs, and research; and reputed company reputed company an initiative that works to eliminate the stigma of mental health challenges. For more information, visit reputed company.org. EOE/MFDV Equal Employment Opportunity and Affirmative reputed company – reputed company (reputed company.org) Apply tot his job Apply To this Job