Job description
SUMMARY:
The Credentialing Manager will act as a leader on our team, working cross-departmentally to ensure accurate submittal of healthcare professionals’ documentation and strategically managing projects across multiple areas of the business. They’ll create and implement new processes to help the team continue to meet and exceed organizational requirements while providing exceptional experiences for Cortica’s healthcare professionals. They will manage the credentialing department in day-to-day operations as well as implement policies and procedures to ensure that applications are properly verified and accurately uploaded into the credentialing system
ESSENTIAL JOB DUTIES AND RESPONSIBILITIES:
- Manages credentialing department in day-to-day operations including any disciplinary action Implements policies and procedures to ensure that applications are properly verified and accurately uploaded into the credentialing system
- Troubleshoot credentialing issues, research, and resolve.
- Identify process improvement opportunities in the processing of credentialing applications.
- Monitors the credentialing application process to promote compliance, process enhancement, and efficiency
- Assures implementation, management, and compliance with Cortica Credentialing and Privileging Program
- Analyzes and prepares reports on trends in application status
- Maintain integrity, security, and relevant HIPPA/PHI compliance by providing professional and personal records. Data includes but is not limited to current state licenses, DEA certificates, malpractice coverage, and any other required credentialing documents for all providers
- Oversee credentialing and re-credentialing applications via electronic/hard copy including accurate information for new and established healthcare providers promptly
- Provide mentorship and training as needed
- Own, track, and manage all public and private payer-provider enrollment and credentialing.
- Maintaining and growing relationships with new and existing providers and third parties.
- Able to work across the organization with other departments that engage with Credentialing Department functions in support of the organization’s clinical and revenue performance goals
NON-ESSENTIAL JOB DUTIES/OTHER FUNCTIONS:
- Maintains established departmental policies and procedures, objectives quality assurance programs, and safety, environmental, and infection control standards.
- Enhance professional growth and development through participation in educational programs, current literature, in-service meetings, and workshops.
- Attends meetings as required and participates in committees as directed.
- Performs other related duties as assigned or requested.
COMPETENCIES:
To perform the job successfully, an individual should demonstrate the following competencies:
Teamwork - Exhibits objectivity and openness to others’ views; gives and welcomes feedback; contributes to building a positive team spirit; puts success of team above own interests.
Planning/Organizing - Prioritizes and plans work activities; uses time efficiently; plans for additional resources; conserves organizational resources.
Computer Skills - To perform this job successfully, an individual should have a strong knowledge of computer operating systems.
Customer Service - Maintains professional demeanor when dealing with difficult or emotional situations; response promptly to employees, clients, and company needs; Solicits feedback to improve service; response to requests for service and assistance.
Analytic Skills - Must have Critical thinking skills to research and resolve discrepancies, denials, appeals, and collections.
Interpersonal Skills - Keeps emotions under control; remains open to others' ideas and tries new things. shows respect and sensitivity for cultural differences; promotes a harassment-free environment.
Oral and Written Communication - Listens and gets clarification; response well to questions; participates in meetings; reads and comprehends written and verbal instructions. writes clearly and informatively.
Professionalism - Tactfully approaches others; reacts well under pressure; treats others with respect and consideration regardless of their status or position; accepts responsibility for own actions; follows through on commitments.
Quality - Demonstrates accuracy and thoroughness; looks for ways to improve and promote quality; applies feedback to improve performance; monitors own work to ensure quality.
Safety and Security - Observes safety and security procedures; reports potentially unsafe conditions; uses equipment and materials properly.
Attendance and Punctuality - Is consistently at work and on time; arrives at meetings and appointments on time; works agreed hours.
Dependability - Follows instructions, responds to management direction; takes responsibility for own actions; meets commitments; follows policies and procedures.
WORKING CONDITIONS AND ESSENTIAL PHYSICAL DEMANDS:
The environmental factors described here are representative of those that may be present in the workplace while the team member performs the essential functions of this job.
Team members in this position may encounter prolonged sitting and/or standing.
This position may require working with a diverse group of individuals. Team members in this position may encounter stressful situations where a professional attitude will be required. Multi-tasking is essential as deadlines and frequent interruptions are common.
MINIMUM EDUCATION, CERTIFICATIONS/LICENSES, AND OTHER REQUIREMENTS:
MINIMUM EDUCATION, CERTIFICATIONS/LICENSES, AND OTHER REQUIREMENTS:
- Bachelor's degree in Business or related field preferred
- 5-10 years experience in leadership in Provider Credentialing
- Ability to manage a small group of direct reports
- Having to Demonstrate the ability to work efficiently on a team, in a fast-paced environment where patients come first is critical
- 5+ years of experience in credentialing; 2+ years of supervisory experience
- Strong computer skills are required especially with Microsoft Office, Adobe Reader, and PDF applications
- Experience with operating Credentialing software and databases
- Highly analytical and detail-oriented, problem solver
- Strong written, oral, and interpersonal communication skills
COMPLIANCE
- Maintain the privacy of all patients, teammates, and volunteer information and access such information only on a need-to-know basis for business purposes as required by HIPAA
- Comply with all HIPAA regulations regarding corporate integrity, and security obligations. Report unethical, fraudulent, or unlawful behavior or activity
- Comply with all OSHA regulations and regularly scheduled training
- Comply with all regularly scheduled harassment training
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties and physical demands
About Cortica:
Cortica is a leading provider of advanced neurological therapies for children with autism and other developmental differences. We offer in-home, in-clinic, and telehealth services that empower families to achieve long-lasting, transformative results.
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