Mgr Credentialing in Chesapeake, VA at Beacon Health Options

Date Posted: 9/6/2019

Job Snapshot

Job Description

The Credentialing Manager will be responsible for leading and developing a high performing Credentialing team. He/she will have responsibility of the Credentialing team including coordination of the National Credentialing Committee and Provider Advisory Committee, monthly sanctions and license monitoring, quality audit remediation and rebuttal, policy maintenance, credentialing implementation activities, delegated credentialing oversight and coordination of client and NCQA audits.

Summary: 

The Credentialing Manager will be responsible for leading and developing a high performing Credentialing team. He/she will have responsibility of the Credentialing team including coordination of the National Credentialing Committee and Provider Advisory Committee, monthly sanctions and license monitoring, quality audit remediation and rebuttal, policy maintenance, credentialing implementation activities, delegated credentialing oversight and coordination of client and NCQA audits.

Responsibilities:  

  • Manage daily operation of team to ensure all activities meet or exceed contractual obligations, including task assignments and follow-up.
  • Assess and manage employee skills and performance. Develop and hire a team of high performers. Hold team accountable to performance expectations, goals and performance guarantees. Provide direction to meet all team requirements.
  • Conducts one-on-one with direct reports and team meetings, attends meetings as needed and actively contributes to the Credentialing Department Leadership Team.
  • Coordinates all activities to support the National Credentialing Committee (NCC) and Provider Advisory Committee including preparing materials for upcoming meetings, supporting Committee Chair with meeting facilitation, facilitating next steps after Committee decisions.
  • Oversee and assure monthly sanctions checks are completed timely and thoroughly including investigation of all potential sanctioned providers and appropriate referral of confirmed providers to the NCC. Serves as point of contact with sanctions monitoring vendor. Implement and manage new process for sanctions monitoring of out-of-network providers.
  • Act as liaison between the Credentialing and Audit departments to assure timely remediation or rebuttal of quality errors.
  • Maintain all credentialing policies to assure they are compliant with NCQA, SOC, regulatory and client requirements. Conduct annual review of policies. Present policies to Clinical Quality Committee for changes and annual review.
  • Manage the delegated credentialing oversight process in compliance with NCQA standards including maintaining a log of all delegated providers and their review schedule, conducting oversight audits timely, and presenting findings to NCC.
  • Manage and oversee all activities to effectively support client and accreditation (NCQA) audits including maintaining a schedule of audits, preparing audit universes, credentialing files and other required documents timely, respond to deficiency assessments and develop corrective action plans as necessary and by required deadlines.
  • Responsible for producing reports which monitor all activities within area of responsibility.
  • Responsible for assigning tasks to appropriate specialists for completion and provide follow-up.
  • Maintain thorough knowledge on current National Committee for Quality Assurance standards for Managed Behavioral Health Organizations. Attend seminars when appropriate.
  • Support the credentialing department on new network and client implementations.

Requirements:  

  • Minimum of three years of Provider Credentialing experience.
  • Five years of experience in Healthcare or Managed Care
  • Thorough knowledge of NCQA credentialing standards.
  • Team lead or supervisory experience.
  • Bachelor’s Degree preferred, may substitute Associates degree (or equivalent) and/or experience commensurate with job responsibilities

Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled

At Beacon Health Options, our candidate's data privacy is a top priority. Our recruiting team conducts all communications using official company email (@BeaconHealthOptions.com). Only candidates who have applied for an open position through our Careers page (careers.beaconhealthoptions.com) will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from you.

#LI-7CF1

 #GD

 $NFD

 #CB