Manager,Credentialing

Job Summary: The Credentialing Manager is responsible for overseeing all aspects of credentialing and re-credentialing of WMCAPS providers. This position ensures all health care professionals are appropriately credentialed, which includes the responsibility of maintaining current information on file and within the credentialing database. 

Responsibilities:

• Completion of health care professionals credentialing and re-credentialing applications.
• Data entry of new applications in the credentialing database.
• Collect documentation for licensing, board certifications, proof of professional liability insurance, National Data Bank (NPDB) and/or other sources as required.
• Maintain the credentialing database and ensure up-to-date information is obtained at all times.
• Responsible for monitoring and managing credentialing/re-credentialing requirements to ensure the collection of all required renewal certifications are on file within the required time frame.
• Provide consistent and timely follow-up on all outstanding credentialing/re-credentialing files.
•  Prepare and scan credentialing/re-credentialing files and other credentialing documentation.
• Answer credentialing telephone line and provide support to physicians, practice office staff, health plan contacts and company departments as necessary.
• Process provider/group demographic changes ensuring appropriate documentation has been submitted with the changes, update credentialing database and notify health plans of changes.
• Process provider network terminations, specialty/category changes, etc.
• Cross train within department to support credentialing operations (providing back-up support for telephones, credentialing files, and vacation/PTO).
• Participate in various educational training as required.
• Perform other related duties as assigned by administration.
• Comply with HIPAA and Corporate Compliance program policies and other applicable corporate and departmental policies.
• Maintain privacy and confidentiality at all times.

Qualifications/Requirements:

Experience:  Minimum of three (3) years of supervisory or management level experience in credentialing. Minimum of six (6) years credentialing experience. Experience with CAQH database and application process. Working knowledge of credentialing accreditation regulations, policies and procedures, and standards. Attend meetings and conferences related to job functions and responsibilities.

Education:  High school diploma or equivalent required.  Bachelor’s Degree preferred.

Licenses / Certifications:  N/A

Other:  Occasional evening and weekend work.