Crisis Worker

Description

Position Summary

The Credentialing Manager is responsible for all aspects of the privileging and credentialing process for all FPCN providers. The Manager will process applications, verify information, research application details, and assure processes are in accordance with NCQA standards and applicable laws. The Manager will provide consistent, accurate, and timely credentialing support, enhancing the Network's ability to provide healthcare services. The Credentialing Manager will take responsibility and ownership of all credentialing and enrollment data, including the integrity and accuracy of the systems/software where it is.

Essential Duties and Functions

1. Perform accurate, timely and documented verification of the information provided by the provider and maintenance of the highly confidential credentialing related files.
2. Ensures that all provider credentialing tasks are completed for new hires, according to the current HR/Credentialing checklist. Partner with HR to make the new hire experience a positive one.
3. Create and facilitate completion of clinician applications for payers.
4. Process credentialing and re-credentialing applications of licensed staff including:
5. Non-billable supportive medical staff
6. Billable medical providers
7. Maintains compliance with documentation standards for verification of employee credentialing requirements, including but not limited to licenses, certifications, registrations, permits, educational degrees, association memberships.
8. Tracks and maintains copies of current credentialing documents and performs primary verifications and ensures:
9. State licenses, certificates, malpractice coverage, and other required credentialing documents in confidential provider files.
10. Update CAQH database with quarterly attestations, updating credentialing documents as needed/required.
11. Enters providers' credentials and privileging data into the credentialing database.
12. Tracks and maintains Medicare exclusion checks for entire staff.
13. Coordinates and facilitates monthly Credentialing and Enrollment reporting to all applicable departments.
14. Manages any outsourced Credentialing and Enrollment vendors.
15. Manages software/systems selected for credentialing and enrollment. Assists in the selection of software/systems when needed.
16. Liaisons with Revenue Cycle Team on a regular basis to ensure reciprocal communication re: Credentialing.
17. Other responsibilities as assigned.

Requirements

Qualifications

Certified Professional Credentialing Manager (CPCS Certified Provider Credentialing Manager (CPCS) or Certified Medical Staff Manager (CMCS) by the National Association of Medical Staff Services (NAMSS) preferred.

Proficient in Microsoft Excel, Outlook, Word, and other credentialing/enrollment applications.

Must Have High School Diploma