External Payer Credentialing Manager

Location Addison
Date Posted November 20, 2019
Job ID 10212
Employment Type Direct Hire

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Job Description:

We are assisting our Addison, TX client in a search for an External Payer Credentialing Manager. Primary responsibilities include managing the day-to-day operations of external payer credentialing team and supervision of the team. Will provide guidance in directing the credentialing team in meeting standards, goals and objectives set by the company and likewise, monitor their performance. Management of the day-to-day operations will include, but is not limited to, managing all activities associated with the external payer credentialing and/or re-credentialing processes for all applicable clinicians. Will provide real-time development and coaching guidance as applicable and will ensure the team has all the appropriate resources, data base access, books, materials, etc., to effectively perform the credentialing functions to credentialing requirements. The Credentialing Manager works independently, but reports to the Senior Director of Contracting, and is responsible for coordinating activities of the credentialing team and is required to provide assistance to all departments within the company.

Responsibilities:

  • Provides leadership to colleagues; develops and implements efficient organizational work flows, processes and reporting tools.
  • Initiates proactive, creative problem-solving techniques for credentialing issues related to billing, claims denials, and communication to internal/external payer partners.
  • Establishes and implements strategic goals to align with department and corporate goals and objectives and conducts regular meetings with staff and assure that they are well informed of company goals and objectives, set priorities and discuss progress towards goals.
  • Ensures an excellent service experience for clinicians and payer partners throughout the credentialing process.
  • Promotes professional growth through staff development and working with Senior Director in developing in-service training.
  • Develops and maintains a strong working relationship with external payer partners and internal stakeholders.
  • Partners with key stake-holders to address and/or resolve network provider status and/or issues with payers.
  • Partner with key stakeholders on provider/practice acquisitions to ensure that new provider loads are set up accurately and completed by the payers/plans.
  • Works with all colleague levels and cross-disciplinary groups regarding inquiries with respect to credentialing information and data requests.
  • Plans the implementation of new processes and train staff appropriately. Plan daily/weekly assignments or projects to assure effective coordination of resources, maximum productivity and accomplishment of goals in a timely manner.
  • Assists in development and implementation quality assurance plans to ensure accuracy and timeliness of credentialing.
  • Leads staff in the development of mechanisms to monitor, track and report on effectiveness of credentialing processes, implement and monitor for improvement.
  • Leads staff in review and monitoring of payer credentialing status reports to ensure timely credentialing by the payers.
  • Monitors credentialing turnaround standards for compliance. Develops changes to standards as necessary.
  • Provides on-going group or one-on-one training to staff on all aspects of credentialing.
  • Performs management activities to include on-going feedback on areas of development and/or accomplishments, performance reviews, coaching, and counseling colleagues and discipline, as necessary.
  • Provides on-going opportunity and challenge for staff development.
  • Assists, oversees and/or manages system and process audits.
  • Is available to staff to provide day to day direction and assistance.
  • Enforces corrective action for staff in a fair and consistent manner.

Requirements:

  • Bachelor's degree (BA or BS) from a four year college or University, or 2-4 years of related experience or training.
  • Direct experience in credentialing required. Minimum of 5+ years credentialing experience with at least 3 years of management/supervisory experience preferred.
  • Knowledge of credentialing software (IntelliCred) preferred.
  • Working knowledge of credentialing processes, procedures and systems.
  • Working knowledge of computer software applications to include Word, Excel, Power Point, Outlook and ability to utilize proprietary software programs.
  • Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures, standardized instructions, short correspondence, and memos.
  • Demonstrated excellent communication skills, both written and oral, with varying levels of colleagues, management, clients and customers.
  • Ability to interpret, execute and lead team with a variety of instructions furnished in written, oral, diagram, or schedule form.
  • Ability to speak effectively before groups of customers or employees of organization.

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