Vacancy For Credentialing Manager

Job Description

Greetings from Saisystems Health: We are looking for Credentialing & Licensing Manager Job Summary: The Credentialing and Licensing Manager is responsible for managing a team of onshore and offshore staff that hold responsibility for processing payor enrollment and credentialing and provider licensing tasks. The Credentialing and Licensing Manager will work with the licensing and/or credentialing Leads and specialists to ensure processes exist to verify provider credentialing's and enforce payor and regulatory compliance and quality assurance. This role maintains all the records and documentation of the application and verification process within the required software application. The department has strong file organization and record retention policies. Job Responsibilities: Provides leadership and management support including, but not limited to, the following: Provide supervision and direction to licensing staff and credentialing team leads and staff in order to meet departmental objectives. Sets and monitors production standards, key metrics and scorecards that are updated weekly Develop, monitor and continuously improve credentialing processes and reporting to ensure data integrity and consistency with strategic corporate goals and objectives, while continuously evaluating current processes looking for more efficient solutions. Ensures 100% adoption of credentialing tools and software by staff. Establishes and maintains strict provider record retention processes to ensure team access to documentation required to perform all duties. Works with offshore Audit and Training team to identify areas of focus for audit and enhancing new hire and active staff training. Build relationships with key customers and work with SAI credentialing and licensing team and customer to set project priorities. Build and establish relationships with state licensing boards, credentialing agencies, and managed care organizations. Maintains knowledge of current health plan and agency requirements for licensing and credentialing providers. Establish priorities daily, if needed, for staff to ensure that provider target start dates are met for new hires, growth and recredentialing review and track requests to add new and remove terminated providers from the group when necessary. Participate on cross-functional project teams and attends Credentialing and Licensing related meetings as necessary. Problem solve by conducting written and oral follow up with group point of contacts, non-responsive providers, verification organizations and/or appropriate departments, as needed, to assist with obtaining credentialing packets and other documentation. Maintains strict level of confidentiality on all matters pertaining to provider. Performance management and counseling of employees when needed, make recommendations and participate in corrective action, as needed. In collaboration with the Director of MSO Delivery, determine department staffing and hiring needs based on current and prospective project demand. Departmental responsibility for establishing staff time and record keeping procedures and serves to confirm month end customer invoice accuracy and contract compliance. Services, as needed, with members of the sales team or customer relationship management team to be a subject matter expert and to participate in upselling opportunities where possible. Experience & Skills Necessary for Position: Minimum 3 years of credentialing management experience Strong knowledge of the healthcare payor environment, escalations, policies and guidelines. Knowledge of credentialing and enrollment systems and processes Knowledge of current CMS regulations Demonstrated knowledge of provider licensing processes. Demonstrate an understanding of healthcare management, including staffing and leading Strong, professional communications skills both written, verbal and presentation to effectively communicate with all customer leadership and providers. Commitment to excellence and high standard Ability to prioritize and multi-task Knowledge and proficiency with Microsoft Excel (pivot tables, macros), Word, Power Point and Outlook is required If Interested feel free to reach us on, Contact Person : P SAIKRISHNA Contact Number & Mail : 93420 77692 skamalapathi@health.saisystems.com