Sr. Credentialing Manager - Our Billing Co LLC

Our Billing Co. is seeking a Sr. Credentialing Manager to join our team!  

The Sr. Credentialing Manager is an important member of Our Billing Team. This individual is responsible for overseeing and coordinating the credentialing process for new and established providers at Kaleida Health. The Sr. Credentialing Manager coordinates very closely with the Medical Staff team, and outside vendor to ensure there is no delay in ensuring revenue generation for new and existing providers for payers requiring credentialing. Oversees and engages in the preparation of the correspondence, gathering payer credentialing paperwork, and filing through the insurance carriers for new and re-certification. Communication and follow through are critical in the success of the payer credentialing prior to a provider’s start date. 

Leadership Team Functions:

• Acts as staff resource and role model for ethical, professional conduct; Has the ability to provide guidance on processes within credentialing.
• Monitors credentialing processes and identifies areas in need of improvement.
• Participates in the hiring, onboarding, and ongoing training processes of credentialing specialists.
• Delegates duties and projects to appropriate staff, and monitors for accurate and prompt completion.
• Stays apprised of all relevant regulations, standards, and directives from regulatory agencies and third- party payers.
• Stays apprised of changing healthcare trends and leverages technology and automation to develop and deliver new products and services to customers.
• Demonstrates knowledge of safety policies and procedures, and actively maintains a safe and positive work environment.
• Carries out other assignments or special projects as required.

Role Specific Functions:

• Works with other department managers and staff—including physicians, managed care, contracting, and other professional staff—to acquire necessary materials and information for provider certification and licensure to promote organization-wide compliance with credentialing policies and procedures.
• Providers oversight of verification and payer credentialing of health care professions and credentials are in compliance with state and federal standards.
• Oversees process and organization of all-payer credentialing and re-credentialing paperwork with participating insurance companies .
• Maintains a database of practitioner’s training, education, licensing, and experience information.
• Key liaison with Medical Staff team, outside vendor, and IT.
• Holds team accountable for maintaining and obtaining up-to-date provider documentation. 
• Assists in filling out and reviewing applications with practitioners and other applicable staff.
• Performs ongoing provider database maintenance for accuracy and completeness.
• Sets and monitors responsibilities of subordinate staff; strategically distributes tasks and workload appropriately.
• Remains compliant with and knowledgeable of rules and regulations set forth by the Health Information Portability and Accountability Act (HIPAA), Joint Commission standards, the HCQIA, the National Committee for Quality Assurance (NCQA), the Centers for Medicare & Medicaid Services (CMS), as well as state regulations—and relays this information to the necessary parties to ensure ongoing compliance organization-wide.

Minimum/Preferred Qualifications:

• Bachelor’s degree in healthcare-related field or 10 years of relevant work experience required. 
• Certification through National Association of Medical Staff Services (NAMSS) preferred.
• At least five years' experience in credentialing in a hospital or healthcare setting is required.
• A minimum of three years of supervisory responsibilities is required.

Knowledge, Skills and Abilities:

• Exemplary problem-solving and conflict-resolution skills
• Detail-oriented 
• Skilled in synthesizing a wealth of information 
• Exhibits excellent time management and prioritization abilities
• Communicates effectively both one-on-one and in a group setting 
• Capable of following and providing detailed instructions both orally and through written communication
• Experience with credentialing database management software preferred 
• Extensive experience working with Microsoft Office Suite (Word, Excel, PowerPoint, Outlook, Access, Project) 

This position will have a hybrid schedule.

Our Billing Co. offers a competitive benefits package!

Pay Range: $100,000 - $120,000

Individual annual salaries/hourly rates will be set within job's compensation range, and will be determined by considering factors including, but not limited to market data, education, experience, qualifications, and expertise of the individual and internal equity considerations.