Credentialing Manager

Credentialing Manager

A Credentialing Manager plays a crucial role in the healthcare industry, specifically within the administrative and revenue cycle management functions. The credentialing manager is responsible for overseeing the credentialing processes within the organization. ensuring that all healthcare providers meet the necessary qualifications and are compliant with regulatory and accrediting bodies.  This role involves managing a team of credentialing specialists, developing policies and procedures, and maintaining up-to-date records to support the organization's mission of delivering high-quality patient care. 

Compensation: $70,000 - $75,000 plus eligible for annual bonus 

Job Overview: A Credentialing Specialist is responsible for managing the enrollment and credentialing process for healthcare providers to ensure they can bill and receive reimbursement from various insurance payors. They work closely with healthcare providers, insurance companies, and government agencies to facilitate the enrollment and credentialing process and maintain accurate records. 

 

Key Responsibilities:

• Lead, supervise, and mentor a team of credentialing specialists
• Oversee the provider enrollment process with various insurance payors, including Medicare, Medicaid, and private insurance companies, from initial application, verification of credentials, and ongoing monitoring
• Oversee the gathering and completion of all required enrollment applications, forms, and supporting documentation.
• Serve as primary point of contact for credentialing inquiries from internal departments, healthcare providers, and external organizations
• Collaborate with other departments, including Human Resources, Compliance, and Legal, to ensure coordinated efforts in credentialing and provider management
• Maintain and oversee the credentialing database, ensuring accurate and up-to-date provider information
• Ensure that providers meet the necessary qualifications and criteria for enrollment
• Verify and collect the necessary credentials and qualifications of healthcare providers, such as licenses, certifications, and malpractice insurance.
• Submit credentialing applications to insurance companies and monitor the status of the credentialing process.
• Address any deficiencies or discrepancies in credentialing applications.
• Ensure compliance with regulatory requirements and deadlines related to provider enrollment and credentialing.
• Act as a liaison between healthcare providers and insurance companies, addressing inquiries and resolving issues related to enrollment and credentialing.
• Communicate the status of enrollment and credentialing processes to relevant stakeholders.
• Ensure that all enrollment and credentialing processes are compliant with applicable laws and regulations.
• Generate reports and maintain data on enrollment and credentialing activities.
• Identify and resolve any enrollment or credentialing issues that may arise during the process.
• Collaborate with internal teams to streamline and improve enrollment and credentialing procedures.

Benefits: 

• Full health and wellness (Medical, Dental, Vision)  
• Flexible spending account  
• 401K with 4% match  
• Company paid life insurance  
• Voluntary life/AD&D, short/Long term disability   
• Positive work environment/culture  
• Company paid holidays  
• PTO  

Qualifications:

• Bachelor's degree in healthcare administration, business, or a related field preferred
• 3-5 years' experience in healthcare provider credentialing, licensing and/or hospital privileging is required
• Knowledge of credentialing processes, healthcare regulations, including Medicare and Medicaid enrollment requirements
• Strong organizational skills and attention to detail
• Excellent communication and interpersonal skills
• Proficiency in using relevant software and databases for data entry and recordkeeping

MindCare is a leading provider of round-the-clock telepsychiatry and in-person behavioral health that provides services to hospitals, emergency departments and a variety of other care settings. We partner with healthcare organizations to deliver best-in-class, end-to-end behavioral health solutions that combine evidence-based care pathways, advanced technology, and high-quality providers. 

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Last updated on Aug 28, 2024