Job Detail

Job Description

• Review the approval and termination of professional provider contracts as they relate to the credentialing process.
• Ensure accurate and timely information for the purposes of re-credentialing, data analysis, and directory generation as well as recommending changes to the credentialing criteria and processes.
• Maintain all credentialing and re-credentialing policies and processes to ensure that they are in compliance with and all applicable regulations.
• Develop and implement departmental policies and procedures that guide and support the provision of services.
• Assist client onboarding department with credentialing and insurance documentation and support as per client needs.
• Leads, schedules, coordinates and oversees the successful completion of audits from state regulatory agencies.
• Interact with all clients to ensure prompt and accurate communication as needed to provide the service expected and to meet the goals of the service.
• Develop new ideas and/or systems with innovation and creativity.
• Lead by example and serves as a professional role model.
• Responsible for the continuous assessment and improvement of the quality of care and services provided.
• Adhere to all Compliance & Integrity Program rules and requirements
• Manage all New Client Account setup, Research, and Development activities.
• Manage VAS (value-added services), provider enrollment, claims submission, and various other projects.
• Train and guide team members on new challenges in the healthcare industry along with keeping close coordination with providers (clients).

Mandatory Requirements:

We’re seeking an independent, detail-oriented team player with:

• Minimum 1 year of recent credentialing experience is required.
• Ability to organize and prioritize work, organizational abilities and manage multiple priorities.
• Excellent verbal and written communication skills including, letters, memos and emails.
• Demonstrated communication skills to obtain and convey information clearly, accurately and in a timely manner
• Strong verbal & written communication skills and good in cross-functional interactions & coordination
• Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization

Skills Required

• COMMUNICATION