Provider Credentialing & Integrity Lead

Page Mechanical Group, Inc.; Town of Florida (NY); On-site; USD 59,000 - 73,000; Full time

Job summary

Page Mechanical Group, Inc. is seeking a Program Integrity Manager in New York to oversee credentialing verification for the provider network and conduct ongoing audits of credentials, licensure, and qualifications.

The role collaborates with Contracts and Compliance and reports to the Senior Director of Provider and Stakeholder Partnerships. The position requires extensive knowledge of Florida/related credentials, strong analytical skills, and the ability to manage on-call rotations and

Qualifications

• MA/MS in behavioral health required.
• Knowledge of Florida licensing rules for therapists required.
• 10 years of clinical experience preferred.
• Florida Licensed Mental Health Counselor or Licensed Clinical Social Worker required.

Responsibilities

• Credentialing verification SME: verifies credentials, education, licensure and certifications for providers.
• Screen new providers and monitor ongoing audits of existing providers.
• Utilize Florida Medicaid Provider Search to verify participation in state programs.
• Perform license verification through Florida Health Department databases.
• Interface with the Managing Entity to review provider status and performance.
• Lead on any concerns regarding deception or misrepresentation by providers.
• Ensure compliance with regulatory, accreditation and contractual requirements.

Skills

Influence

Relationship building

Responsiveness

Trust & respect

Customer service

Innovation

Sensitivity

Ethics

Education

MA/MS in behavioral health

Florida Licensed Mental Health Counselor or LCSW

Job description

Page Mechanical Group, Inc. is seeking a Program Integrity Manager in New York to oversee credentialing verification for the provider network and conduct ongoing audits of credentials, licensure, and qualifications.

The role collaborates with Contracts and Compliance and reports to the Senior Director of Provider and Stakeholder Partnerships. The position requires extensive knowledge of Florida/related credentials, strong analytical skills, and the ability to manage on-call rotations and