District Medical Group is hiring for a Credentialing Manager.
Under the direction of the Credentialing Director, the Credentialing Manager will assist with the daily operations of the credentialing department.
What You Will Do:
- Provide management and direction to the department providing oversight of staff and/or programs (i.e., credentialing, database management, health plan enrollment, etc).
- Participate in staff recruitment, development, orientation, education and evaluation of staff competencies and provide mentoring and coaching to staff.
- Develop and monitor processes and procedures that support initial credentialing, re-credentialing, and health plan enrollment
- Provide administrative oversight to ensure compliance with accrediting and regulatory agencies (i.e., NCQA, Joint Commission, DNV, URAC, Federal and State Agencies) as it relates to credentialing
- Coordinate and assess credentialing staff to assure accurate and timely processing of health plan enrollment for providers.
- Apply regulatory standards to the credentialing process in order to obtain delegated credentialing status with all willing health plans. If required, develop action plans in accordance with recommendations received from health plans during delegated audits to ensure continued delegation.
- Manage various committee activities (i.e., scheduling, agendas, minutes, research and coordination, etc.).
- Exhibit a high degree of responsibility for confidential matters.
- Aid Central Billing Office, Prior Authorization, Division staff and health plan representatives with issues that may be hindering the billing process related to a provider’s health plan status in order to assist in the reimbursement process.
- Maintain knowledge of standards of the National Committee on Quality Assurance (NCQA), the Joint Commission, Det Norske Veritas (DNV) Healthcare and State and Federal regulations related to credentialing.
- Develop and maintain open communication with Providers, Executive Staff, Division staff, provider’s office staff and DMG staff. Identify and work to solve problems as they arise.
- Develop and maintain professional networking contacts at hospitals and health plans promoting DMG and representing DMG at third party contractor audits of credentials files.
- Coordinate health plan delegation audits and complete required monthly and quarterly statistical data submissions.
- Coordinate distribution of provider rosters and monthly delegated submissions to health plans.
- Coordinate scheduling regular staff meetings and involve staff in decision-making whenever appropriate.
- Manipulate provider database to extract information for ad hoc reports, surveys, and internal and external extracts. Design and implement statistical reports to extract data in format required by various regulatory agencies. Investigate and resolve database inconsistencies and institute policy to ensure process improvement.
- Process all requests for provider membership and privileges at hospitals, long term care facilities and other contracted locations as required to include processing and tracking required fees.
- Coordinate documentation for all provider terminations, notifying provider, health plans, facilities and DMG staff.
- Provide back-up coverage for Credentialing Director and other credentialing staff as needed.
- High school diploma or equivalent
- Certification by the National Association of Medical Staff Services in Certified Professional Medical Services Management (CPMSM). If not holding the CPMSM certification, the certification must be attained within two years of beginning employment.
- Dual certification including Certified Professional Credentialing Specialist (CPCS) preferred
- Five + years of progressive responsible credentialing or medical staff services related experience that demands a strong understanding of the required knowledge, skills and abilities.
- 3+ years’ in a leadership role in medical environment
- 3+ years’ experience with NCQA credentialing standards
Who We Are:
DMG is well known as one of the leading and most respected healthcare organizations in the Phoenix area, with a reputation for outstanding leadership, innovation and dedication to the patients and community we serve. We employ over 650 credentialed providers and over 350 professional and administrative staff, and are the largest physician group in the Valley.
What We Offer:
- Competitive compensation plan
- Phenomenal benefits package - eligible on DAY ONE
- 401K plan with employer match
- FSA plan
- 10 paid holidays
- Great team environment
- Pay Type Salary
- Required Education High School
- Job Start Date Tuesday, December 22, 2020