CHE Services

  • Credentialing Manager

    Job Locations US-CA-Carlsbad
    ID
    2019-1758
    Category
    Management
    Type
    Full-Time
  • Overview

    CHE is a premier provider of behavioral health services and is the partner of choice for over 600 skilled care facilities. CHE has been operating for over 20 years in multiple states and employs over 800 clinicians. We deliver a unique programmatic approach to behavioral health services and are focused on quality and compliance for facilities. Our programs are designed to enhance facility clinical services, regulatory compliance, survey preparedness and reimbursement maximization. We go beyond the traditional role of a consultant and integrate ourselves as a vital member of the multi-disciplinary team. 

     

    General Summary:

     

    Management position responsible for leading, coordinating, monitoring, and maintaining the accuracy and integrity of the provider credentialing, facility onboarding, payor credentialing/re-credentialing, and facility privileging processes across all CHE markets (NY, CA, NJ, PA, CT, GA, TN, and KY). Provides oversight of 5-person team of credentialing coordinators and outside parties, while maintaining working knowledge of the provider enrollment requirements for various regional Medicare Administrative Contractors (“MACs”), state Medicaid programs, Council for Affordable Quality Healthcare (“CAQH”), and managed care insurance companies.  This position requires high attention to detail, flexible task management, and strong team leadership and team development skills. Individual is responsible for credentialing accuracy, credentialing turnaround time, and authorizing clinicians for billable services.

     

    Supervises Credentialing Coordinators in CHE’s Brooklyn, NY and Carlsbad, CA offices.

     

    #CB

    Responsibilities

    Essential Job Responsibilities

    1. Oversees the operations and deliverables of the entire credentialing department.
    2. Supervises credentialing personnel, which includes work allocation, training, and problem resolution.
    3. Evaluates performance and makes recommendations for personnel actions; motivates employees to achieve peak productivity and performance.
    4. Serves as the practice expert and go to person for all credentialing processes and usage of credentialing systems.
    5. Prepares provider rosters and engages payor credentialing representatives from managed care insurance companies to ensure provider rosters are maintained accurately.
    6. Leads in the drafting and/or development and implementation of operating policies and procedures.
    7. Provides and/or oversees training for new and existing credentialing staff on applicable operating policies, protocols, systems and procedures, standards, and techniques.
    8. Understands and stays current with current credentialing related regulations and compliance requirements, including health information management issues such as HIPAA.
    9. Performs other miscellaneous job-related duties as assigned.

    Qualifications

    Education

    • Associates degree.
    • Bachelor's Degree preferred.

    Experience

    • Minimum of two to four (2-4) years in provider onboarding, payor credentialing, facility privileging or other related health care operations experience.
    • Minimum of one to two (1-2) years supervisory experience.

    Knowledge

    • Thorough understanding of credentialing requirements of Medicare, state Medicaid programs, managed care insurance (Aetna, United, BCBS, etc.), and CAQH standards.
    • Knowledge of multi-state credentialing requirements for various disciplines including states of NY, CA, NJ, CT, PA, GA, TN, KY, and disciplines including Psychologists, Licensed Clinical Social Workers, Nurse Practitioners, Psychiatrists, and Physician Assistants.
    • Familiarity with setting up policies and procedures to enable NCQA-certified delegated credentialing preferred.

    Skills

    • Skilled in establishing and maintaining effective working relationships with other employees, clinicians, health care facilities, insurance companies, and regulators.
    • Detail-oriented in own work and in maintaining quality standards of credentialing team.
    • Working knowledge of or strong ability to learn our credentialing software system (Echo OneApp).
    • Highly skilled in developing, implementing, and administering workflow processes.
    • Shifts easily among competing tasks to meet deadlines.
    • Ability to supervise and train employees, to include organizing, prioritizing and scheduling work assignments to meet credentialing timelines.
    • Effectively communicate in writing and verbally with physicians, insurers, colleagues and staff.
    • Proficient in Microsoft Excel, Word, email, and Adobe Acrobat.

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