It's rewarding to be on a team of people that truly believe in making an impact! We are committed to building the best primary care environment for patients and are seeking healthcare enthusiasts to join us. Job Summary The Credentialing Manager oversees the operations to develop, manage and monitor processes and procedures that support the credentialing, re-credentialing, expirable data management, and delegated credentialing contract processes. Oversees all the credentialing functions including application management and primary source verification. Ensures compliance with the appropriate accrediting and regulatory agencies. Supervises credentialing staff in the day-to-day management of the overall credentialing process and database management. Duties & Responsibilities Essential Duties & Responsibilities Administrative/Accreditation Duties: Provides direct supervision of a professional support staff in administering all aspects of the credentialing services with a strong emphasis on the delivery of quality, efficiency, and superior service. Implements policies and procedures to ensure that applications are properly verified and accurately uploaded into an online credentialing database system. Conducts research to process new health plans applications for providers. Provides consistent, accurate, and timely credentialing support for various internal departments as it relates to credentialing status. Acts as internal resource around issues associated with public funding sources, such as Medicaid and Medicare, as well as private payors. Provides accurate, timely and documented verification of the information provided by new applicants as well as current providers. Regularly communicates with internal departments on all completed provider health plans enrollments and provides status updates. Verifies, researches, and responds to telephone and written inquiries from payors, providers and other departments, pertaining to provider participation and credentialing status. Conducts outreach to payors, telephonically and in writing, requesting status of provider credentialing. Schedules and attends meetings with payors to discuss provider credentialing status. Coordinates all provider additions, terminations, and changes to all plans. Prepares and maintains reports on all provider accreditation and credentialing activities as required, Quality Assurance/Credentialing Duties: Coordinates the management of the credentialing database and associated modules, ensuring accuracy of data and reporting to downstream systems. Monitors critical data for analysis and report generation. In conjunction with Human Resources (HR) maintains compliance with documentation standards for verification of employee credentialing requirements, including but not limited to, licenses, certifications, registrations, permits, educational degrees, internship, residency and association memberships and any related electronic systems and software. Ensures all required re-verifications are performed during hiring and thereafter. (i.e. National Practitioner Data Bank). Ensures all records are properly kept for all providers (i.e. the National Practitioner Data Bank, CAQH, and the Utilization Review Accreditation Commission). Collects, enters and ensures data in the CAQH Universal Provider Data Source are updated. Participates in the coordination between the payors and medical centers of on-site visit(s) for credentialing purposes. In conjunction with the Compliance Associate, ensures the Center’s credentialing process fully complies with HIPAA and Joint Commission, as applicable. Ensures that on-line training (e.g., payor portals, Government and State portals) is current as required. Supervisory Responsibilities Will supervise the credentialing specialists. Critical Results Credentialing for New Physicians/Acquisitions <120 days> 90% Credentialing Accuracy > 98% Credentialing database management and accuracy >98% Education & Experience A minimum of 2 years of experience in credentialing management, privileging, or similar healthcare professional verification and organization’s accreditation processes are required. Minimum 2 years of experience in health plan enrollments and management is required. Experience in insurance management is highly preferred. Credentialing Specialist (CPCS) is preferred. Education Requirements Education Level Discipline Required High School Knowledge, Skills & Proficiencies Principles of effective analysis and highly effective writing. Principles and practices of health care systems and medical administration. Skill in operating phones, personal computers, software, and other IT systems. Skill in oral communication Ability to communicate with associates, payors, and other individuals in a professional and courteous manner. Ability to pay close attention to detail and to ensure accuracy of reports and data. Fluent in English and Spanish Physical Requirements This position works under usual office conditions. The employee is required to work at a personal computer as well as be on the phone for extended periods of time. Must be able to stand, sit, walk, and occasionally climb. The incumbent must be able to work extended and flexible hours, as needed. Physical demands include the ability to lift to 50 lbs. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Work Conditions Must be able to perform essential functions such as typing, standing, sitting, stooping, and occasionally climbing Travel Requirements Amount of Expected Travel Details No 0-25% Tools & Equipment Used Computer and peripherals, standard and customized software applications and tools, and usual office equipment. Disclaimer The duties and responsibilities described above are designed to indicate the general nature and level of work performed by associates within this classification. It is not designed to contain, or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of associates assigned to this job. This is not an all-inclusive job description; therefore, management has the right to assign or reassign schedules, duties, and responsibilities to this job at any time. Cano Health is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law. Join our team that is making a difference! Please see Cano Health’s Notice of E-Verify Participation and the Right to Work post here Together, we have the opportunity to serve and grow with purpose. Find your team and begin your journey of transforming healthcare! Let us know you’re interested in a future opportunity by clicking ‘Get Started’ below. For more updates and engagement, create an account by clicking ‘Sign In’ above.