What are the responsibilities and job description for the Manager, Credentialing position at Independent Living Systems?
We are seeking a Manager, Credentialing to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.
About the Role:
The Manager, Credentialing plays a critical leadership role in overseeing the credentialing processes for healthcare providers within the organization. This position ensures that all practitioners meet the necessary regulatory, accreditation, and organizational standards to deliver safe and compliant care. The manager will lead a team responsible for verifying qualifications, licenses, certifications, and professional backgrounds, maintaining accurate and up-to-date records. They will collaborate closely with internal departments and external agencies to streamline credentialing workflows and resolve any compliance issues promptly. Ultimately, this role safeguards the integrity of the provider network and supports the organization's commitment to quality and patient safety.
Minimum Qualifications:
- Bachelor’s degree in healthcare administration, business, or a related field.
- Minimum of 5 years of experience in healthcare credentialing or provider enrollment.
- Strong knowledge of credentialing standards, including NCQA, The Joint Commission, and CMS requirements.
- Experience managing teams and coordinating cross-functional projects.
- Proficiency with credentialing software and Microsoft Office Suite.
- Relevant experience may substitute for educational requirement on a year-for-year basis.
Preferred Qualifications:
- Master’s degree in healthcare administration, business, or a related field.
- Certified Provider Credentialing Specialist (CPCS) or equivalent certification.
- Experience working within a large healthcare system or managed care organization.
- Familiarity with electronic health record (EHR) systems and provider data management.
- Advanced degree in healthcare administration or related discipline.
- Demonstrated success in process improvement and regulatory compliance initiatives.
Responsibilities:
- Lead and manage the credentialing team to ensure timely and accurate processing of provider applications and re-credentialing activities.
- Develop, implement, and maintain credentialing policies and procedures in compliance with regulatory requirements and accreditation standards.
- Coordinate with internal stakeholders such as HR, compliance, and medical staff offices to facilitate credentialing and privileging processes.
- Monitor and audit credentialing files to ensure completeness, accuracy, and adherence to organizational and regulatory standards.
- Serve as the primary point of contact for external credentialing bodies, licensing boards, and healthcare networks.
- Analyze credentialing data and generate reports to inform leadership on compliance status and operational performance.
- Provide training and guidance to staff on credentialing best practices and regulatory changes.
- Manage vendor relationships related to credentialing software and verification services.