Manager, Credentialing in Latham, NY at Beacon Health Options

Date Posted: 2/11/2020

Job Snapshot

Job Description

We Help People Live their Lives to the Fullest Potential!

For more than 30 years, Beacon has changed the way people live with behavioral health conditions. Today, we are the undisputed leader in behavioral health management, serving 40 million people across all 50 states. At Beacon, we are committed to delivering a ‘world-class’ candidate experience from the moment you click ‘Apply’! Our goal is to help you reach your fullest potential, while utilizing your talents and expertise to help us deliver on our promise.

Do you have a passion for helping others? If so, we are looking for you!

Beacon is currently seeking a Manager, Credentialing a highly organized and compassionate professional to join our team at our Latham, NY offices or Remote.  The Manager, Credentialing is responsible for leading and developing a high performing Delegation and Client Oversight team. Functions that are the responsibility of the Delegation and Client Oversight team include coordination of delegation arrangements overseeing delegated entities and remaining prepared and responding to delegation arrangements with Beacon partners and clients. This entails ongoing audits, monitoring rosters and delegate updates as well as responding and resolving corrective action plans. The Delegation and Oversight team will be responsible for collaborating with applicable departments and leadership to ensure Beacon remains compliant with NCQA accreditation, CMS regulations, and state specific requirements meeting credentialing requirements

What does a typical day look like?

  1. Oversees daily operation of team to ensure all activities meet or exceed contractual obligations, including task assignments and follow-up.
  2. Provides direction and leadership to support a high performing team, accountable to performance expectations, goals and performance guarantees.
  3. Conducts regular 1:1s with direct reports, leads team meetings and represents the Credentialing Department as needed at larger department meetings, actively contributing to the Leadership Team.
  4. Maintains thorough knowledge on current National Committee for Quality Assurance standards for Managed Behavioral Health Organizations and Health Plans, as well as CMS guidelines mandated to remain compliant for Medicare and Medicaid Products. Proficient in state mandates for behavioral health and Medicaid products, including abilities to research appropriately. Attends seminars when appropriate. Maintains or obtains certification in profession. Conducts annual reviews of all credentialing policies to assure they are compliant with NCQA, SOC, regulatory and client requirements. Presents policies to Clinical Quality Committee for changes and annual review.
  5. Oversees adherance to client, regulatory, and accreditation (NCQA) audits including maintaining a schedule of audits, preparing audit universes, credentialing files and other required documents timely. Responds to deficiency assessments and develops corrective action plans as necessary and by required deadlines.
  6. 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.
  7. Oversees monthly sanctions checks and ensures they are completed thoroughly and on time, including investigations of all potential sanctioned providers and appropriate referral of confirmed providers to the NCC. Serves as point of contact with sanctions monitoring vendor. Manages processes for sanctions monitoring of out-of-network providers.
  8. Produce performance results reports for leadership across all activities within area of responsibility.
  9. Acts as liaison between the Credentialing and other departments to maintain timely remediation or rebuttal of quality errors.
  10. Manages new network and client implementations related to credentialing activity.
  11. Performs oversight and conducts Credentialing Department’s process improvement and transformational initiatives to drive completion and successful outcomes evidenced by team metrics consistently performing at or above expected production standards.
  12. Using production and quality audit results, provide staff feedback and perform individual and group training as indicated.

 What you Contribute?

Education: Bachelor’s Degree, experience may be considered in lieu of degree.

Licensure: Certified Provider Credentialing Specialist Certification (CPCS) and/or Certified Professional Medical Services Management (CPMSM) required.

Knowledge, Skills & Abilities:

  • Min 5 yrs experience in health care or managed care, provider credentialing experience.
  • Minimum 2 years in a people management role with demonstrated strong project management and leadership skills. Well versed in NCQA.
  • Professional demeanor, strong written and oral communication skills and the aptitude to quickly learn our internal systems.
  • Detail-oriented, analytical, highly organized and possessing problem-solving skills.
  • Ability to manage varying priorities, meet deadlines and handle multiple tasks simultaneously with minimal supervision.
  • Advanced computer literacy (Outlook, Word and Excel) and adept at documenting and improving issues within workflows or processes that obstruct team productivity and quality.
  • Collaborative and team-oriented work philosophy.
  • Effective people manager, leader and highly organized.
  • Customer-centric service skills, with a focus on overall process improvement and commitment to consistent productivity and quality.
  • Comfortable working in PowerPoint, conducting group presentations and speaking publically.
  • Travel required: 5% - 20% Varies by location

What Makes Us Different?

  • Here, it’s not just a job – it’s an opportunity to change lives.
  • Our employees are learners, innovators and original thinkers.
  • Our mission and values guide the way we treat our members, providers and each other.

What We Have to Offer:

  • Healthcare benefits available starting day 1!
  • Health & wellbeing incentives, such as gym membership reimbursement
  • 401K with company match to help reach your future financial goals
  • Generous PTO, because we know life happens outside of work
  • Tuition reimbursement so you can keep reaching your fullest potential

If Beacon sounds like the place for you, what are you waiting for? Apply with us today to get started!

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.

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