Manager, Credentialling

Careabout; Evesham Township (NJ); Remote; USD 59,000 - 88,000; Full time

Job summary

A leading healthcare organization seeks a Credentialing Operations Manager responsible for overseeing the credentialing team. The role involves to ensuring compliance with laws and standards, managing relationships with stakeholders, and improving processes. Ideal candidates will have management experience in healthcare credentialing and a strong understanding of regulatory requirements.

Benefits

Health, dental, and vision insurance

401K with automatic employer contribution

PTO and Paid Holidays

Voluntary short and long-term disability insurance

Access to various Wellness programs

Qualifications

• 5+ years of management experience, with at least 2 managing a credentialing team.
• Relevant practice and IPA credentialing experience required.
• Strong understanding of Medicaid/Medicare regulations.

Responsibilities

• Lead the credentialing team to ensure compliant provider processing.
• Support Director in managing credentialing activities according to standards.
• Ensure accuracy of credentialing database and provider data.

Skills

Management

Credentialing

Problem Solving

Communication

Interpersonal Skills

Education

Bachelor’s Degree

Job description

CareAbout Health is a managed services organization (MSO) that provides expert advice, resources, tools, and other support to its portfolio of medical groups and healthcare focused companies. CareAbout Health is helping align incentives to create a world where patients, providers, and payers work together in a seamless, coordinated manner toward common goals: higher quality, lower cost, better outcomes.

Role Title: Credentialing Operations Manager

Role Location: Remote

Reporting Relationships:

This position reports to the Director of Credentialing

Role Summary and Responsibilities:

The credentialing manager is responsible for leading the credentialing team to ensure compliant and efficient provider processing in accordance with all applicable laws, payor contracts, and delegated credentialing standards.

Key Responsibilities / Essential Functions:

Understand and comply with all payors and state regulations/standards/laws related to all credentialing, provider data management, and payer enrollment activities

Support Director in managing all provider credentialing activities in accordance with NCQA and payer standards for delegated and non-delegated relationships

Follow standard operating procedures in accordance with all contractual and regulatory requirements

Management and training of credentialing team

Represent on Payer meetings as needed

Internal and external liaison for issue resolution

Facilitate malpractice applications, policy management, and Certificate of Insurance distribution for providers and PLLC

Responsible for:

CAQH profiles of the group and providers

Provider rosters internally and at payor level

Facilitation on hospital affiliation request and renewals for physicians

Master provider and location rosters

Manage communications across internal teams

Meet or exceed in quality, performance, financial, and operational targets as established by leadership

Improve the processes/workflows and performance of the credentialing team

Develop, interpret, and execute functional objectives

Coordinates the processing, distribution, and management of all credentialing and accreditation documents for affected providers.

Maintain accuracy and completeness of credentialing database. Maintain and track provider licensure, requesting current version from appropriate parties when necessary.

Review payer plan applications returned to department for accuracy and completeness and reprocessing of same.

Assist in ensuring that provider participation in the payer plans and CAQH is current, accurate and up to date.

Maintains and ensures strict confidentiality of files and databases.

Non-Essential Functions:

Other duties, as assigned.

Qualifications:

Bachelor’s Degree required.

5+ years of management experience with at least 2 years managing a delegated credentialing team.

Relevant practice and IPA credentialing experience.

Medicaid / Medicare / State and Managed Care Plan regulatory experience.

Managed Care experience.

Primary source verification experience.

Preferred Qualifications:

Network Management contracting experience.

Demonstrated knowledge of the healthcare industry.

Strong work ethic.

Strong Instructional and interpersonal skills.

Highly driven and ability to self-direct.

Ability to work effectively with clinical leadership and site operations.

Ability to communicate effectively in verbal and written forms.

Ability to troubleshoot, problem solve and work as a team as well as independently.

Ability to multi-task, prioritize workload to meet deadlines, and pay attention to detail.

Physical Requirements:

Mainly sedentary.

Sitting at the desk most of the day.

Standing or walking less than two hours per day.

Lifting no more than ten pounds on rare occasions.

Must be able to work at a computer and answer phone calls on a regular basis.

The compensation range for this position is $59K/yr. - $88K/yr.

Featured Benefits:

Health, dental, and vision insurance.

401K with automatic employer contribution.

PTO and Paid Holidays.

Access to voluntary short and long-term disability insurance.

Access to additional life insurance.

Access to a variety of Wellness programs.

CareAbout Health is committed to providing an environment of mutual respect where equal opportunities are available to all applicants and employees without regard to actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth, related medical conditions and lactation), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, disability, protected medical condition as defined by applicable state or local law, genetic information, or any other characteristic protected by applicable federal, state, or local laws and ordinances (referred to as “protected characteristics”).

We are interested in every qualified candidate who is legally able to work in the United States without sponsorship. We cannot offer any visa sponsorship now at this time.

Compensation is based on the level and requirements of the role.

Salary within our ranges may also be determined by your education, experience, knowledge, skills, abilities, and location, as required by the role, as well as internal equity and alignment with market data.

About Us

CareAbout Health is a physician-led transformative care solution, creating an ecosystem that utilizes a technology-enabled platform and whole-person care delivery model to support our network of providers and their patients.

Our platform provides access to value-based care arrangements, is equipped with analytics, provider tools and workflows and the required care management support needed to succeed.

We continue the work to identify and solve seemingly impossible problems in healthcare; to align incentives between patients, providers, and payors; and to raise the floor in underserved communities. Ultimately, CareAbout Health envisions a world where healthcare professionals and systems work together in an efficient and effective manner to significantly and sustainably improve patients’ lives.