Manager – Credentialing, Provider Data Operations
USAble Life
full-time
Posted on:
Location Type: Remote
Location: Florida • United States
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Salary
💰 $81,000 - $117,000 per year
About the role
- Manage the credentialing process for all plan Partners in accordance with the NCQA guidelines and CMS accreditation standards, and Federal and State laws.
- Monitor the currency of rules, regulations, and policies and procedures, ensuring compliance with NCQA guidelines.
- Participate in the development and review of CVO policies and procedures, recommend and implement changes, revisions, and enhancements as appropriate to current operating environment
- Coordinate the management of the provider, practice and credentialing on-boarding process and database management ensuring accuracy of data utilized for provider directory, claim processing and reporting
- Monitor critical data for extensive analysis and report generation
- Coordinate the management of credentials application to ensure distribution, receipt, processing and timely delivery
- Coordinate the management of expirable process to ensure all provider licenses and certificates remain current ensuring appropriate notification prior to expiration
- Monitor and report turnaround time for processing of credentials applications and provider demographic and contract affiliation change requests, with focus on delivery of a high-quality product with the greatest efficiency, in the least amount of time
- Oversee and coordinate credentialing audits in compliance with downstream entities.
- Work directly with Dental Director and Credentialing Committee to ensure all files are reviewed, signed off on, and any follow-up action completed
- Perform all activities associated with staffing including staff evaluations.
- Provide guidance and feedback to staff to improve departmental service levels and efficiency
- Performs other related duties and responsibilities as assigned
Requirements
- Bachelor's Degree, or related experience
- 3-5 years' experience leading credentialing programs, projects and, relationships
- 2 or more years supervisory experience
- Strong knowledge of the health or ancillary insurance industry
- Advanced experience working with credentialing and provider data management
- Excellent communication skills including the ability to address a wide range of audiences
- Ability to work within time constraints and maintain attention to detail
- Strong customer service skills
- Intermediate MS Office skills
- Experience with administration systems including SalesForce and SpringCM
- Ability to write reports, business correspondence and memos
- Ability to define problems, collect data, establish facts, and draw valid conclusions
- Skilled in developing policy and procedure documentation
- Employee development and performance management skills
Benefits
- A people‑first culture that values diversity, inclusion, and belonging
- Outstanding and affordable benefits
- PTO available starting on your date of hire
- 11 paid holidays
- 401(k) plan with up to a 6% company match, fully vested from day one
- Company‑provided equipment
- A collaborative, team‑focused environment
- Career development and advancement opportunities
- Tuition Reimbursement
- Employee Assistance Program
- Inclusion Council and Employee Resource Groups
- Recharge Days and Volunteer Time Off
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
credentialingprovider data managementpolicy developmentreport writingdata analysiscompliance monitoringauditingproject managementstaff evaluationsperformance management
Soft Skills
communicationcustomer serviceattention to detailproblem-solvingleadershipguidancefeedbacktime managementinterpersonal skillsorganizational skills