Manager, Credentialing

We’re unique.  You should be, too.

We’re changing lives every day.  For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts?  Do you inspire others with your kindness and joy?

We’re different than most primary care providers. We’re rapidly expanding and we need great people to join our team.

The Manager, Credentialing is responsible for managing credentialing projects and all aspects of provider credentialing within the organization. The incumbent in this role serves as a liaison, facilitating communications between markets and payer credentialing staff. The incumbent will engage with payers, center/market/regional leadership, and HR Ambassadors to ensure a seamless, efficient and more strategically defined credentialing program to ensure improved processes to establish new providers while reducing issues and gaps.

ESSENTIAL JOB DUTIES/RESPONSIBILITIES:

• Leads the credentialing team day to day: hiring, coaching, performance management and workload distribution to meet turnaround standards.
• Oversees the entire credentialing and recredentialing process from start to finish.
• Runs daily credentialing and recredentialing operations for providers, pharmacies and dispensaries in line with NCQA primary source verification requirements.
• Oversees the licensing program (state licenses, DEA/CDS, board certification) and ensures renewals are completed before expiration.
• Oversees provider enrollment and directory accuracy through the Lead Enrollment Coordinator and Lead PCBM, and owns the status reporting for both.
• Executes the credentialing QI program: file audits, baseline measurement, deficiency tracking and corrective action follow-through.
• Keeps credentialing files audit-ready and coordinates file pulls and responses for payer and pre-delegation audits.
• Executes CVO delegation requirements: payer reporting, oversight deliverables and ongoing compliance with delegation agreements.
• Manages the Credentials Committee process: file preparation, agendas, minutes and follow-up on committee decisions.
• Maintains the credentialing database (Verifiable and Workday) and keeps the data accurate.
• Coordinates the annual review and update of CVO policies and procedures.
• Maintains team metrics and dashboards, and reports performance to RCM leadership.
• Ensures Pharmacy Benefit Manager (PBM) agreements are updated and executed on time.
• Establishes and manages medical group structures, making sure all entities are accurately enrolled in the right health plan networks.
• Performs other duties as assigned and modified at manager’s discretion.

KNOWLEDGE, SKILLS AND ABILITIES:

• Expert knowledge and understanding of multi-state Medicare, Medicaid and commercial payor enrollment requirements
• Advanced knowledge of physician/provider credentialing requirements
• Understands delegated credentialing requirements from payors
• Ability to lead projects and organize and lead multi-disciplinary project teams through associated project activities
• Ability to influence all levels of organizational leadership to help drive process, strategy and adherence to proper business protocols

• Skilled in computer applications including MS Word,

• Skilled in verbal and written communications.

• Ability to work independently with limited supervision.

• Spoken and written fluency in English

• This job requires use and exercise of independent judgment

EDUCATION AND EXPERIENCE CRITERIA:

• BA/BS degree in Health Services Administration or a closely related field required OR additional experience above the minimum may be considered in lieu of the required education on a year-for-year basis

• Five (5) years of Credentialing experience required

• One (1) year experience in a Lead/Management capacity preferred

• Experience working in CAQH Pro-View and Medicare (PECOS, NPPES, and I&A) required

• Certified Provider Medical Services Management (CPMSM) / Certified Provider Credentialing preferred

• Specialist (CPCS) Certification preferred

PAY RANGE:

$70,396 - $100,565 Salary

The posted pay range represents the base hourly rate or base annual full-time salary for this position. Final compensation will depend on a variety of factors including but not limited to experience, education, geographic location, and other relevant factors. This position may also be eligible for a bonuses or commissions.

EMPLOYEE BENEFITS

https://chenmed.makeityoursource.com/helpful-documents

We’re ChenMed and we’re transforming healthcare for seniors and changing America’s healthcare for the better.  Family-owned and physician-led, our unique approach allows us to improve the health and well-being of the populations we serve. We’re growing rapidly as we seek to rescue more and more seniors from inadequate health care. 

ChenMed is changing lives for the people we serve and the people we hire.  With great compensation, comprehensive benefits, career development and advancement opportunities and so much more, our employees enjoy great work-life balance and opportunities to grow.  Join our team who make a difference in people’s lives every single day.

Current employees, if you want to apply to our internal career site, please click HERE

Current Contingent Worker please see job aid HERE to apply

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