Scope:

The Credentialing Manager plays a pivotal role in ensuring that our healthcare providers are credentialed and enrolled with insurance payers efficiently and accurately. Meticulous attention to detail and organizational skills are instrumental in maintaining compliance and efficiency in the credentialing processes.

Responsibilities

• Manage MSO services; hire and oversee team, comprising of VHA’s (Virtual Health Associates)
• Oversee the completion of credentialing applications for new providers, ensuring accuracy and timely submission to insurance payers
• Monitor and track the status of credentialing applications, proactively identifying and addressing any delays to ensure timely approval
• Maintain comprehensive provider credentialing files and databases, ensuring all information is up-to-date and compliant with regulatory requirements
• Serves as the primary point of contact for communication with insurance payers and provider representatives to resolve any credentialing issues or discrepancies
• Collaborate with internal departments to gather necessary information for credentialing applications and facilitate seamless coordination
• Lead the re-credentialing and re-validation processes for existing providers, ensuring ongoing compliance and accuracy
• Work closely with the billing department to facilitate accurate reimbursement for services rendered by providers
• Stay abreast of healthcare industry trends and changes in credentialing requirements, providing recommendations for process improvements as needed

Requirements

• Bachelor’s degree in healthcare administration, business management, or a related field
• Minimum of 1 years experience in a managerial role within healthcare credentialing
• In-depth knowledge of credentialing processes and requirements for various insurance payers
• Proficiency in Microsoft Office applications and credentialing software (e.g., CAQH, NAMSS)
• Exceptional communication skills with the ability to effectively liaise with internal stakeholders and external partners
• Strong organizational skills and the ability to prioritized and manage multiple tasks simultaneously
• Thorough understanding of HIPAA regulations and compliance requirements
• Leadership qualities with the ability to motivate and mentor team members

Disclaimer: This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.

We use E-Verify to confirm the identity and employment eligibility of all new hires.

Job Type: Full-time

Pay: $58,000.00 - $63,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Referral program
• Vision insurance

Schedule:

• Monday to Friday

Education:

• Bachelor's (Required)

Experience:

• Management: 2 years (Required)
• Credentialing: 1 year (Required)

Ability to Relocate:

• Las Vegas, NV: Relocate before starting work (Required)

Work Location: In person