Manager, Provider Intake & Credentialing

Overview

Oversees the credentialing and intake of physicians and providers for VNS Health Plans. Develops credentialing policies and procedures designed to ensure efficient work flows and ensure compliance with applicable regulatory and accreditation agencies. Works under general supervision.

What We Provide

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life Disability
• Employer-matched retirement saving funds
• Personal and financial wellness programs 
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care  
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement 
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities  
  
  

What You Will Do

• Manages provider intake process which includes contracting handoff, credentialing and configuration of providers for VNS Health Plans. Evaluates current processes and workflows; makes recommendations for improvement as appropriate.
• Ensures that due diligence is performed on all entities to which credentialing may be delegated. Oversees credentialing reviews/audits in accordance with established policies and procedures. Monitors the delegated entities performance and reports findings to the Credentialing Subcommittee.
• Manages compensation grid configuration in Salesforce and Facets Environment.
• Coordinates and participates in training of department staff, including development of materials, demonstration of new systems and processes.
• Oversees investigations and reconciliation of credentialing/re-credentialing workflow issues. Leads the research and resolution of escalated issues related to applications and verification.
• Collaborates with Quality Improvement/Management Departments in quality assurance monitoring and evaluation of network providers. Evaluates and analyzes findings from audits and works with appropriate staff to develop/implement corrective plan of action, as needed.
• Identifies and reports trends to management; develops reports that recognize and identify potential/suspected issues. Manages reports for all metrics to ensure department goals are met and/or exceeded. Provides recommendation to address trends and resolve issues to ensure provider satisfaction.
• Manages, monitors and audits initial and re-credentialing process for contracted providers in collaboration with department staff. Conducts audits for in-network providers with delegated credentialing responsibilities and ensures required documentation is up-to-date. Follows-up with providers to investigate/resolve re-credentialing issues and apprises Credentialing Committee and senior leadership, as necessary.
• Performs all duties inherent in managerial role. Recommends hiring, salary actions, performance appraisals, promotions, termination and performs orientation/training to facilitate the professional growth and development of assigned staff.
• Participates in special projects and performs other duties as assigned.
  
  

Qualifications

Education:

Bachelor's Degree in Health Administration, Business Administration, related discipline, or equivalent work experience required. Master's Degree preferred

Work Experience

Minimum of five years experience in health care delivery systems required. Minimum of two years managerial experience preferred. Experience working in healthcare administration and/or operational programs required. Experience working with healthcare providers as customers or clients required. Thorough understanding of network contracting and credentialing required. Intermediate level Microsoft Office, with high proficiency in Excel required. Salesforce experience preferred

Pay Range

USD $93,400.00 - USD $116,800.00 /Yr.

About Us

VNS Health is one of the nation’s largest nonprofit home and community-based health care organizations. Innovating in health care for more than 130 years, our commitment to health and well-being is what drives us — we help people live, age and heal where they feel most comfortable, in their own homes, connected to their family and community. On any given day, more than 10,000 VNS Health team members deliver compassionate care, unparalleled expertise and 24/7 solutions and resources to the more than 43,000 “neighbors” who look to us for care. Powered and informed by data analytics that are unmatched in the home and community-health industry, VNS Health offers a full range of health care services, solutions and health plans designed to simplify the health care experience and meet the diverse and complex needs of the communities and people we serve in New York and beyond.