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SENTA is seeking a highly motivated and experienced Credentialing Manager to join our team. The Credentialing Manager will be responsible for managing the credentialing process for all healthcare providers within our organization, ensuring compliance with regulatory and accrediting agency requirements.
·Develops and maintains credentialing/re-credentialing processes to continually increase the efficiency and efficacy of credentialing for internal and external stakeholders.
·Reviews existing, develops new and maintains Credentialing Policies and Procedures, desktop policies and advises on the development of critical corporate guidelines and best practices.
·Supervises Credentialing Specialists, monitors their performance, identifies and addresses performance improvement opportunities.
·Manages credentialing submissions with expediency and accuracy with efficient internal and external communication throughout the process.
·Communicates and works to improve interdepartmental relationships with Credentialing, Recruitment, Human Resources, Revenue/Billing, Legal/Compliance, and other designated departments.
·Researches and analyzes issues, ensures appropriate documentation to identify outcomes and accurately interprets internal and external guidelines and policies.
·Develops, implements, and manages processes to create, update and maintain practitioner files for enrollment purposes and for ensuring accurate and timely completion of credentialing and practitioner enrollment.
·Prepare management and operational reports for internal and external customers.
·Maintains current Credentialing database up to date.
·Completes ongoing file review on an intermittent basis to identify objectives, error rates, timeliness and use data as an opportunity to counsel staff, as appropriate.
·Establishes and maintains production and quality metrics for Credentialing Specialist(s).
·Facilitates problem solving of operational and revenue cycle issues through collaboration with client health plans and internal stakeholders.
·Manages multiple projects simultaneously and under tight deadlines.
·Assists with resolution of contract and claim issues related to practitioner enrollment and identifies and communicates opportunities for process improvement.
·Responds to inquiries regarding practitioner credentialing and enrollment.
·Maintains confidentiality of all credentialing information in compliance with federal and state statutes, as well as SENTA policies.
·Perform other job duties as assigned.
Full Time
$85k-115k (estimate)
04/21/2023
06/11/2024
sentapartners.com
Atlanta, GA
<25
The job skills required for Credentialing Manager include Billing, Problem Solving, Confidentiality, Collaboration, etc. Having related job skills and expertise will give you an advantage when applying to be a Credentialing Manager. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Credentialing Manager. Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for Credentialing Manager positions, which can be used as a reference in future career path planning. As a Credentialing Manager, it can be promoted into senior positions as a Compliance Director - Healthcare that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Credentialing Manager. You can explore the career advancement for a Credentialing Manager below and select your interested title to get hiring information.