The Credentialing Manager will oversee day-to-day activities of staff that process credentialing and re-credentialing applications for providers. The Credentialing Manager will assist with review of credentials and licenses for new therapy and psychiatry providers to ensure credentials are up-to-date and accurate. The Credentialing Supervisor will oversee coordination of provider enrollment and re-enrollment with insurance providers.
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Responsibilities:
1. Ensure that applications are properly verified and accurately uploaded into an online credentialing database system.
2. Administer system for tracking license and certification expirations to ensure renewals are submitted in a timely fashion.
3. Reviews and screens initial and reappointment credentialing applications for completeness, accuracy, and compliance with federal, state, and local guidelines, policies, and standards.
4. Conducts primary source verification, collects, and validates documents to ensure accuracy of all credentialing elements; accesses completeness of information and qualifications relative to credentialing standards.
5. Identifies, analyzes, and resolves extraordinary information, discrepancies, time gaps, and other intricacies that could adversely impact ability to credential and enroll practitioners.
6. Monitors files to ensure completeness and accuracy; reviews all file documentation for compliance with quality standards.
7. Enters, updates, and maintains data from provider applications into credentialing database with accuracy.
8. Participates in the development and implementation of procedures for the credentialing process.
9. Communicates clearly with providers in a timely manner as requested and on day-to-day as credentialing and privileging issues arise.
10. Maintain professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest developments to enhance understanding of various regulations and legislation of the healthcare industry.
11. Performs miscellaneous job-related duties as assigned.
Working hours: 8:00 AM - 5:00 PM
Skills:
Extreme attention to detail
Organized, energetic and positive, and has excellent time management skills
Provide outstanding customer service, multi-tasking, and strong computer skills
Education:
Bachelors
Experience:
4-7 years
Qualifications:
Prior supervisory experience
Over 5 years of multi-state experience directly related to the duties and responsibilities specified
Completed Bachelor???s degree(s) from an accredited institution may be substituted for experience of a year for year basis
Strong computer skills, including Microsoft Word and Excel
Knowledge of medical provider credentialing and accreditation principles, policies, procedures, and documentation
Ability to maintain confidentiality and discretion in all communications on behalf of credentialing applicants and/or applications.
Spherion Staffing & Recruiting has partnered with a well-established therapeutic behavioral health center in the Ft. Myers area looking to directly hire a Credentialing Manger. This center offers a wonderful benefits package and host of other perks. If you have strong credentialing experience in the healthcare industry and are looking for an opportunity that is not just a job but a positive and supportive environment that allows their employees to grow professionally please apply with a current resume for immediate consideration by a member of our Professional Recruiting team!
Spherion has helped thousands of people just like you find work happiness! Our experienced staff will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temp-to-perm or direct hire opportunities, no one works harder for you than Spherion.
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.
At Spherion, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact Callcenter@spherion.com.
Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Spherion offers a comprehensive benefits package, including health, and an incentive and recognition program (all benefits are based on eligibility).
For certain assignments, Covid-19 vaccination and/or testing may be required by Spherion's client or applicable federal mandate, subject to approved medical or religious accommodations. Carefully review the job posting for details on vaccine/testing requirements or ask your Spherion representative for more information.