SPV CREDENTIALING in Latham, NY at Beacon Health Options

Date Posted: 10/5/2018

Job Snapshot

Job Description

ABOUT THE POSITION

Responsible for the daily activities of Credentialing/Re-credentialing teams.  The monitoring activities of job flow include the accurate and timely processing of provider/facility information through manual data entry.  Supervises staff and coordinates training to ensure team meets or exceeds production, accuracy and performance standards.  Ensures staff follows established policies and procedures, and assists team / department in achieving goals and objectives.  The Credentialing Manager must also support the data integrity process in working with the various units within NetOps to ensure appropriate resolution occurs when problems/errors are identified. This position does not have direct oversight of department budgets or decision rights which would impact budgets. 

Position Responsibilities:

  • Manages daily operation of teams to ensure all activities meet or exceed contractual obligations, to include task assignments and follow-up.
  • Provides data on production and accuracy to employees and to management on   a timely basis, with appropriate exception reporting.
  • Ensures all team members are aware of team goals, performance guarantees and status.  Provides direction to meet all team requirements.
  • Ensures credentialing and re-credentialing processes are congruent with policies and procedures approved by the National Credentialing Committee and all accreditation and/or government standards. 
  • Directly responsible for coordinating staff training needs.  Assists in training as needed and ensures maintenance of training materials.
  • Supervises team members, which includes hiring and terminations, ongoing documented supervision, annual reviews, counseling, corrective action and employee recognition under the Human Resources Policies and Procedures.
  • Evaluates staffing requirements and schedules an ongoing and daily basis to ensure staffing meets team/department goals, making recommendations to Credentialing Director as appropriate.
  • Conducts team meetings, attends meetings as needed and actively participates in implementation of new contracts as needed. 
  • Responsible for producing reports which monitor all activities within area of responsibility.

Position Requirements:

Education: Bachelor’s Degree preferred, may substitute Associates Degree (or equivalent) and/or experience commensurate with job responsibilities.

Licenses: Certified Provider Credentialing Specialist Certification (CPCS) credentials (within 8 months of hire).  Must maintain and keep current thereafter.

Relevant Work Experience: Minimum of 3 years working experience in the insurance industry (or appropriate education), with one year of healthcare experience preferred. 

To Apply:

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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

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