Credentialing Manager

The Director of Credentialing is responsible for the oversight of contracting facilities with the insurance companies, credentialing, re-credentialing and applications for contracting. The Director of Credentialing leads the credentialing team to ensure timely and accurate credentialing of healthcare professionals.

POSITION DESCRIPTION / DUTIES

Oversees and maintains the data integrity and functionality of credentialing database; generates reports and prepares audits as requested.

Function as primary contact for all internal and external inquiries regarding Credentialing and Privileging, and potential and/or existing practitioners regarding credentialing.

Oversees and ensures that all necessary licenses and credentials are verified and updated for the respective healthcare facility. This might include conducting background checks through finger printing, contacting licensing boards, reviewing license applications, obtaining education information and interviewing references.

Develop, maintain, and enforce credentialing policies and procedures

Develop processes, programs, tools, education, and proven best practices to increase quality, compliance, effectiveness, and efficiency

Identify opportunities for improvement, recommend solutions to leadership, and implement new practices

Hire, develop, coach, appraise, reward and retain a highly qualified credentialing department staff; motivate and mentor credentialing staff; lead by example through appropriate participation and involvement in and oversight of credentialing activities.

Monitors and evaluates the performance of staff; gives timely feedback; and manages all aspects of staffing to include hiring, training, rewarding, disciplining, and terminating staff.

ABOUT US:

Exact Billing Solutions is a high-performance environment propelled by collaboration through philosophy of Empowering Your Ambition. The expectation for each team member is to provide a supportive high performance work environment. Exact Billing Solutions team members are charged with:

• Identifying challenges and collaborating with team members to design creative solutions and measurable outcomes.
• Motivate and hold team members accountable for excellent service standards.
• Commit to reliable, open and honest communication.
• Learning, teaching and sharing information.
• Both front line and management team members will be invited to participate in leading and driving initiatives to completion.

Technology

Technology is an essential part of managing the needs of our business. Team members are expected to use the instruments and systems identified as efficient and effective methods to manage day to day operations in their role. We encourage feedback on systems and/or instruments that hinder efficient performance.

Environmental Stewardship and Safety

• All Team members are responsible for preserving the cleanliness of the interior and exterior of the facility. Team members are expected to keep work and common break spaces (i.e. employee lounge) free from waste or any unkemptness that would detract from the aesthetics of the environment.
• Team members are expected to adhere to facility safety requirements, report unsafe practices or equipment, and use the appropriate protective equipment as needed.
• During the course of duties team members may have the opportunity to lift, twist, pull or push. Team members must be able to manage these activities up to 60 lbs.
• Any accident or incident must be reported immediately to a member of management for proper recording.
• Adhere to infection control standards and policy

HIPAA

Team members are required to adhere to policies and procedures implementing HIPAA requirements for the privacy and security of protected health information. Team members are permitted to use and/or disclose only minimum amount of Protected Health Information necessary to complete assigned tasks.

Team Members excluded from Federal Healthcare Programs.
Exact Billing Solutions operates facilities that receive federal funding and may not employ or contract with an individual or entity that has been excluded from health care programs (for example, Medicare or Medicaid). Accordingly, if a team member or agent has been excluded from or is under investigation and may be excluded, they must notify a member of management immediately.