Credentialing Manager

The Credentialing Manager is responsible for daily operations and specific administrative functions within the Clinical Health Network for Transformation (CHN) Credentialing team in the Revenue Cycle Department. The Credentialing Manager will work under the supervision of the Vice President of Revenue Cycle and will manage the day-to-day functions related to credentialing, including provider licensing, payer enrollment, initial appointment, re-appointment, expiring documents and other tasks.

Requirements

• Coordinate policies and procedures related to the member affiliate provider credentialing and payer enrollment process.
• Manage the internal credentialing database, ensuring accuracy of data and ability to assess database and utilize reporting.
• Coordinate the management of expirable to ensure all provider licenses and certificates remain current and ensure appropriate notification prior to expiration is provided to all providers.
• Monitor and report turnaround times for processing of payer enrollment applications.
• Coordinate the maintenance and enhancements of the credentialing database.
• Facilitate the credentialing reporting requirements.
• Ensure the team is obtaining, updating, and maintaining the National Plan and Provider Enumeration System (NPPES) / Provider Enrollment, Chain and Ownership System (PECOS) accounts for all APRNs, PAs and physicians.
• Facilitate the maintenance of electronic copies of current state licenses, Board certification, DEA registration and CSR (LA only) certificates, malpractice coverage and any other required credentialing documents for all providers.
• Prepares for and coordinates credentialing audits when needed.
• Oversee the Credentialing Specialist position, which includes work allocation, training, enforcement of internal policies and procedures, problem resolution, holds staff accountable, performance, and problem resolution.
• Interacts with various customers on issues related to credentialing via email and meetings.
• Upholds organizational values and standards, while proactively seeking ways to improve efficiency, equity, and service excellence.
• Ensure compliance with all CHN and affiliate policies, as well as all state and federal regulations.
• Provides positive and development feedback and accountability related to all practices.
• Demonstrates commitment to CHN and Planned Parenthood’s health equity mission, with emphasis on racial equity and community accountability. Demonstrates dedication to learning about racial equity and addressing structural racism in healthcare.
• Consistently delivers high-quality results using sound judgment and data-driven decisions. Prioritizes customer needs by providing prompt, accurate service to all stakeholders.

Benefits

• Health Care Coverage (Medical, Dental, & Vision); eligibility for full-time, regular employees on date of hire
• Flexible Spending Accounts and Health Savings Account
• Short-Term Disability and Basic Life & AD&D Insurance provided by CHN
• Voluntary elections for Long Term Disability and Additional Life & AD&D Insurance available at cost
• Employee Assistance Program
• Retirement Plan, 3% employer match after one year of service
• Paid Time Off Program includes accrual-based PTO, Health Time Off (HTO), and nine (9) paid Holidays