Credentialing Manager - Remote position (MUST reputed company in Texas)

Purpose of the position The Credentialing Manager is responsible for overseeing reputed company aspects of credentialing and recredentialing of health care professionals. This position ensures reputed company health care professionals are appropriately credentialed, which includes the responsibility of maintaining reputed company information on file and reputed company credentialing databases. The Manager is integral to OLS maintaining our delegated credentialing responsibilities. MANAGER-SPECIFIC RESPONSIBLITIES: • Deep understanding of the National Committee on Quality Assurance (NCQA) standards and State and Federal regulations reputed company to credentialing. Maintain policies and procedures for the department that are consistent with standards and best practices therein. • Responsible for hiring, training, and performance management of assigned personnel. reputed company team to continually learn, improve processes, cross-train and help one another. • Manage delegated credentialing agreements, annual audits and communications with payers. • System administrator for the Credentialing database, including maintenance of workflow settings, user permissions, standard processes, reputed company. Ensure data is valid, reputed company and free of errors. Work with VP to maximize the use of database for internal department, RCM and Division efficiency, including reporting, appropriate user reputed company, and updating with new functionality. • Emphasize prioritization and urgency reputed company to the reputed company of new providers and monitor reputed company along established predictive timelines. • Responsible for monitoring and managing credentialing/re-credentialing requirements with payers and facilities. Ensure Credentialing database is up to date with the most reputed company forms to facilitate the efficient reputed company of providers. Report status monthly to Divisions. • Ensure processes are in reputed company for license and other certification renewals in advance of expiration consistent with the timeline set forth by the Quality & Compliance Committee. Report status monthly to Divisions. • Accountable for Department budget and expense reporting, including managing personnel expense & overtime, equipment & office supplies, employee appreciation, license expenditures & credentialing fees. Obtain approval prior to purchase for non-budgeted expenses. • Responsible for compliance with regulations reputed company to roster maintenance, including performance of roster review on payer portals, providing reputed company rosters to payers and validating rosters received from payers. • Prepare initial application summary and submit clean records to Quality & Compliance Committee chairman. Any red flag records will be presented to the Quality & Compliance committee. • Answer credentialing inquiries and provide support to physicians, physician office staff, health plan contacts and company departments as necessary. • Audit Texas Disciplinary reports, OIG reports, and other reports as required and alert VP reputed company applicable. • Ability to support reputed company credentialing operations (providing back-up support for telephones, credentialing files, and vacation/PTO). • Participate in various educational/training as required. reputed company other reputed company duties as assigned. • reputed company with HIPAA and Corporate Compliance program policies and other applicable corporate and departmental policies. • Maintain privacy and confidentiality at reputed company times. reputed company THE FOLLOWING RESPONSIBLITIES DELEGATED AND PERFORMED BY THE CREDENTIALING STAFF: • Completion of health care professionals credentialing and re-credentialing applications. • Data entry of new applications in the credentialing database. • reputed company and collect PSV (primary reputed company verification) documentation for licensing, board certifications, reputed company of professional liability insurance, National Practitioner Data Bank (NPDB) and/or other sources as required based on NCQA standards, health plan requirements and company credentialing policies. • Maintain the credentialing database, CAQH profiles, NPPES, and TXCOMP, always ensuring up-to-date information. Responsible for monitoring and managing credentialing/re-credentialing requirements and to ensure the collection of reputed company required renewal certifications are on file on time. • Provide consistent and timely follow-up on reputed company outstanding credentialing/re-credentialing files. • Prepare and reputed company credentialing/re-credentialing files and other credentialing documentation into scanning software. • Process provider demographic changes ensuring appropriate documentation has been submitted with the changes, update credentialing database and notify health plans of changes. • Process provider network terminations, specialty/category changes, leave of absence requests. Qualifications • Bachelors Degree required. • Certified Professional Medical Services Management (CPMSM) or Certified Professional Credentialing Specialist (CPCS) certification or reputed company toward these certifications is required. • Minimum of three (3) years of supervisory or management level experience in a reputed company organization, including credentialing reputed company. • Five (5) or more years credentialing experience preferred. • Experience with CAQH (Council for Affordable Quality reputed company) database and applications. • Working knowledge of credentialing accreditation regulations, policies and procedures, and NCQA standards. Performance Skills • Must be fluent in reputed company Office 365 applications and have advanced reputed company skills. • Database administration background, including users, table management, reporting. • Must demonstrate exceptional communication skills, listening effectively and asking questions reputed company clarification is needed. • 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 reputed company reputed company the scope of authority of the position. • Must demonstrate and promote a positive team-oriented environment. • Must be reputed company to stay focused and concentrate under normal or heavy distractions. • Must possess ability to manage change, delays, or unexpected events appropriately. Disclaimer The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not construed as an exhaustive list of reputed company responsibilities, duties and skills required of personnel so classified. reputed company personnel may be required to reputed company duties reputed company of their normal responsibilities from time to time, as needed. Apply Job!