The Credentialing Manager oversees the operations of the Aria Care Partners Credentialing Department, to develop, manage, and monitor processes and procedures that support the credentialing, re-credentialing, expirable data management, and delegated credentialing contract processes of all Aria Care Partners Service Lines. The Manager oversees all the credentialing functions including application management and primary source verification. The Manager ensures compliance with the appropriate accrediting and regulatory agencies. The Manager also supervises credentialing staff in the day-to-day management of the overall credentialing process and database management.

Essential Duties & Responsibilities

• Ability to make administrative/procedural decisions and judgments.
• Ability to investigate and analyze information and draw conclusions.
• Ability to develop and deliver presentations.
• Ability to process computer data and to format and generate reports.
• Ability to supervise and train employees, to include organizing, prioritizing, and scheduling work assignments.
• Ability to communicate effectively, both orally and in writing.
• Ability to foster a cooperative work environment.
• Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.
• Skill in developing policy and procedure documentation.
• Database management skills.
• Employee development and performance management skills.
• Knowledge of related accreditation and certification requirements.
• Knowledge of medical credentialing and privileging procedures and standards.
• Knowledge of medical policies, regulations, and bylaws and the legal environment within which they operate.
• Problem solving — Identify and resolve problems in a timely manner.
• Planning/organizing — Prioritize and plan work activities and use time efficiently.
• Quality control/Attention to detail — Demonstrate accuracy and thoroughness; monitor own work to ensure quality and apply feedback to improve performance.
• Proficient with Microsoft Office including Excel
• Cross train within department to support credentialing operations (providing back-up support for telephones, credentialing files, vacation/PTO).
• Participate in various educational/training as required.
• Perform other related duties as assigned by Chief Compliance Officer.
• Comply with HIPAA, PPI, PHI, and Corporate Compliance program policies and other applicable corporate and departmental policies.
• Ability to plan, assign, supervise, and evaluate the work of others, and to monitor goals, objectives, deadlines, and priorities.
• Demonstrate accuracy, organizational and problem-solving skills. Look for ways to improve and promote quality and monitors own work to ensure quality is met.
• Maintain confidentiality.
• Ability to assume responsibility and exercise good judgement in making decisions within the scope of authority of the position.

Education & Training Requirements

• Minimum of three (3) years of supervisory or management level experience in credentialing.
• Minimum of three (3) years credentialing experience.

• Associate or Bachelor’s degree preferred; or equivalent work experience.

• Experience with Modio provider credentialing program preferred.
• Experience with CAQH (Council for Affordable Quality Healthcare) database and application processes.
• Experience with Medicare and Medicaid, MCOs, and Health Plans/Insurance Standards.
• Experience with Adobe, Smart Sheets, NPPES, and PECOS.

Other Qualifications

• Adaptability — Adapt to changes in work environment, manage competing demands and deal with frequent change, delays, or unexpected events.
• Dependability — Consistently at work and on time, follow instructions, responsive to Leadership direction, and solicit feedback to improve performance.
• Able to work in team environment.

Physical Effort & Working Conditions

• No or very limited physical effort required.
• No or very limited exposure to physical risk.
• Work is normally performed in a typical interior/office work environment.