Credentialing Manager - Physician Services

Job Family:

Travel Required:

Clearance Required:

What You Will Do:

The Credentialing Manager is responsible for overseeing the daily operations of a project(s) and the management of the assigned team members when applicable.  The Manager is typically an extension of a client’s business office staff. This position is to develop, manage and monitor processes and procedures that support the credentialing, re-credentialing, expirables data management and notification, and delegated credentialing contract processes. Oversees all credentialing functions including application management and re-attestations. Supervises credentialing staff in the day-to-day management of the overall credentialing process and database management. This position will follow and ensure that client policies and procedures are followed and will also perform any and all job-related duties as assigned.

Essential Job Functions

• Strong leadership and management skills

• Display thought leadership with credentialing function and the relationship with the revenue cycle.

• Client contact and interaction

• Possess interpersonal, organizational, delegation and analytical skills

• Ability to plan workflow and implement policies and processes

• Monitor and ensure team member compliance with state and federal Laws and guidelines

Duties and Responsibilities

• Provides operational direction for the credentialing team across multiple clients.

• Coordinates the management the credentialing database and associated modules, ensuring accuracy of data and reporting to downstream systems.

• Monitors critical data for extensive analysis and report generation.

• Coordinates the management of the electronic credential’s application, to ensure distribution, receipt, processing, and timely delivery

• Coordinates the management of the expirables process to ensure all clinical provider licenses and certificates remain current, ensuring appropriate notification prior to expiration.

• Coordinate and conduct interviewing of potential new hires and bring recommendations to Operations Manager

• Training of new team members

• On-going training and mentoring of team members

• Complete monthly quality reviews for each credentialing representative on the project

• Ensure team member and project compliance with HIPAA standards

• Receives and reviews client project reports generated from supervised team members

• Monitor and ensure all staff member’s compliance with Company/Client standards

• Monitor team member phone calls for adherence to client and Company/Client expectations

• Monitor team member attendance and punctuality

• Communicate team member non-compliance with Operations Manager

• Conduct disciplinary counseling including performance improvement plans as required

• Complete annual evaluation of staff

• Complete all assigned projects in a timely manner

• Conduct weekly team meetings to ensure the on-going understanding of client and company expectations

• Monitor and ensure team members meet or exceed established productivity goals

• Identify and communicate trends and issues to Operations Manager & Client

• Works with management in developing policies

• Promote teamwork and a positive work environment

• Possible travel

Client Responsibility

• Verify accuracy of all correspondence prior to sending to the client

• Provide scheduled and requested reports

• Ensure timely completion of enrollment and credentialing processes based on client and company guidelines

• Ensure compliance of all client policies and procedures by staff

• Research and respond to all client inquiries received by telephone and mail

What You Will Need:

• Requires a university degree and a minimum 7 years of prior relevant experience. Relevant experience may be substituted for formal education or advanced degree.

• 4+ years supervisory experience in a patient access, HIM or PFS functions within either hospital, physician, or dental space

• 2+ years experience with managing credentialing project/function

• Experience with credentialing software technology

• PC skills in a Windows environment are required

• Knowledge and utilization of desktop applications to include Word and Excel is essential

What Would Be Nice To Have:

• Expertise in provider/payer credentialing. Deep knowledge of the process. Familiar with Credentialing software and reporting.

• Ability to initiate and follow through on projects and work independently

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What We Offer:

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Benefits include:

• Medical, Rx, Dental & Vision Insurance

• Personal and Family Sick Time & Company Paid Holidays

• Position may be eligible for a discretionary variable incentive bonus

• Parental Leave

• 401(k) Retirement Plan

• Basic Life & Supplemental Life

• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts

• Short-Term & Long-Term Disability

• Tuition Reimbursement, Personal Development & Learning Opportunities

• Skills Development & Certifications

• Employee Referral Program

• Corporate Sponsored Events & Community Outreach

• Emergency Back-Up Childcare Program

About Guidehouse
Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at RecruitingAccommodation@guidehouse.com. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.