At USA Clinics Group, we use our expertise to provide the best possible service for our patients. Our team members are passionate about making a difference in the lives of the people we treat and are constantly striving to improve and better ourselves so that we can better support our patients and are currently searching for a Credentialing Manager to join our team!
As the Credentialing Manager you would be responsible for overseeing the credentialing and re-credentialing process for all providers in 170+ clinics across 30 states.
Responsibilities:
- Processes physician accreditation, managed care, governmental and commercial insurance enrollment and re-credentialing
- Responsible for daily provider data management and review of credentialing files for accuracy and completeness, utilizing internal and external sources
- Responsible for analyzing clinic utilizations and develop physician location scheduling recommendations
- Analyze local payor IPA markets for partnerships or payer contracting opportunities
- Performs primary source verification via various state and national sources
- Maintains individual provider credential files with all the appropriate documentation consistent with AAAHC and NCQA standards
- Oversees, updates and maintains provider credential database including CAQH, PECOS, NPPES Registry, Sharepoint any other applicable regulatory agencies
- Develops and prepares analytical reports monthly/quarterly of the summary of credentialing activity
- Responds timely to provider inquiries by letter, phone or internal communication
- Work closely and maintain relationships with provider relations at each payer, and communicates any challenges and/or concerns with manager timely
- Maintain Credentialing Applications for accuracy and completeness
- Work to develop automation Bots to streamline the applications/Enrollment process
- Additional duties as assigned
Requirements
- Bachelor's degree preferred, Associates degree required
- 5-years experience with medical credentialing of physicians with various insurance companies, required
- Negotiation of contracts and fee schedules experience, preferred
- Familiarity with medical terminology through education or relevant work experience
- Immaculate attention to detail and excellent proofreading skills
- Strong Analytical and data manipulation skills
- Excellent organizational skills
Benefits
- Health
- Dental
- Vision
- 401k amp; Match
- PTO