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Credentialing Manager
Posted on 5/20/2022
Experience Level
Desired Skills
Data Analysis
  • High School Diploma or GED
  • BA Degree required
  • Minimum 4 years credentialing experience
  • Minimum 2-years of team lead/management experience
  • CPMSM or CPCS certification
  • Experience with implementation and operation of electronic credentialing software
  • Proficient in developing KPIs and and reviewing analytics pertaining to team performance
  • Excellent technology skills including Excel, Word, and email use. Ideally will be comfortable with Google suite of applications
  • Detail oriented with excellent organizational, project management, and process improvement skills
  • Plans and prioritizes to meet deadlines
  • Excellent communication skills; communicates clearly and effectively
  • Strong communication and interpersonal skills
  • Manage a team of credentialing specialists to ensure successful payer enrollments and listing on payer directories
  • Serve as the practice's primary internal medical staff credentialing expert and resource
  • Liaise with external payer contacts and internal contracting colleagues to address any challenges or backlogs with regards to payer enrollments and payer directories
  • Drive process improvement to ensure timely, effective, and compliant workflows
  • Develop and oversee processes to ensure timely and effective completion of collaborating agreements between physicians and mid-level providers, based on state guidelines
  • Work closely with the Revenue Cycle Director, operations and billing staff to identify and resolve any denials or authorization issues related to provider credentialing
  • Lead and implement delegated credentialing in compliance with NCQA and payer standards
  • Ensure compliance with all relevant accreditation and regulatory requirements
  • Drive reporting and analytics pertaining to performance of the credentialing team
  • Perform monthly Exclusions & Sanctions reporting to the Compliance Officer
  • Oversee successful credentialing specialist activities, including:
  • Maintaining individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications
  • Maintaining internal provider grid to ensure all information is accurate and logins are available
  • Updating each provider's CAQH database file timely according to the schedule published by CMS
  • Completing revalidation requests issued by government payers
  • Completing credentialing applications to add providers to commercial payers, Medicare, and Medicaid
  • Completing re-credentialing applications for commercial payers
  • Maintaining accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases
  • Maintaining an internal provider data management directory and also provide at minimum quarterly updates for commercial payers and CMS portals

51-200 employees

Company Overview
With their unique ability to see all aspects of patients' lives, Heal will improve health outcomes, strengthen provider-patient relationships, and make primary healthcare affordable and accessible, because everyone deserves to Heal.
  • Work from home remote opportunities
  • Three weeks paid vacation
  • Employer paid comprehensive health plans
  • Competitive salary, stock options and 401(k)
  • Six weeks parental leave
  • FSA plans and employer paid
  • Short Term Disability
Company Values
  • Relationship-Focused - We practice what we preach. Seamless communication comes from building healthy and trustworthy relationships with our teammates and patients.
  • Patient-First - Our patients give us purpose. Patient-care, repairing the healthcare system, and providing an improved quality of life to all is our aspiration.
  • Do The Right Thing - We are open, honest and act with integrity in every situation. We prioritize the safety of all the personal information and data across our platform.
  • Innovation-Infused - We see beyond the horizon and believe in a brighter future through the power of technology. We always seek new solutions and are open to try new things.
  • Empathy - Heal was born from the understanding of the need for comprehensive, quality, and convenient healthcare. Empathy is woven into the fabric of who we are as we demonstrate interest, care and concern for others.