Responsible for routine operations within the credentialing department. This includes development and improvement of existing and new team members, specifically regarding processes, productivity, and interpersonal skills. Training new and existing employees as needed. Distribution of tasks. Responsible for assisting manager and handling all or most issues in the manager’s absence.  

Responsible for training and educating employees in new physician enrollment process, credentialing software, working hold report, working provider related remarks, and other tasks performed in the payor credentialing process. Responsible for creating and updating SOP’s for the department. Effectively communicate with Operations Managers and or Directors on a regular basis. This includes process delays due to missing or incomplete information, payor issues, etc. Pull and analyze reports from credentialing software and billing system. Report issues to manager and resolve as necessary. Compile statistics at month end regarding holds, providers in process, expirables, and other data points as requested. Regular quality audits of completed applications to ensure completeness and accuracy for each staff member. Communicate with MMG contracting to ensure regular and accurate exchange of information. Frequent payor websites and newsletters to keep informed of changes in process, forms, etc.  Educate staff on process changes. Work with IS department to ensure current payor forms are uploaded to credentialing software at all times.   Perform credentialing duties in the absence of credentialing clerks. Approve time off requests for credentialing staff. Reassign duties amongst staff when necessary due to extended absences, vacation, or special projects. Go to person for credentialing clerks regarding problem solving and credentialing questions. Performs related duties, as required.

 

Equal Opportunity Employer of Minorities/Females/Disabled/Veterans

Required:

Associates degree in healthcare administration or related field or High School Diploma and two years of credentialing experience Minimum 1 year credentialing experience Knowledge of CAQH, NPPES, BCBSM EDI TPA online application, CHAMPS (Medicaid enrollment), CMS and PECOS (Medicare enrollment) and third party payor applications. Must be able to communicate professionally with all providers, CEO’s VP’s and Directors of all MHCC entities.

Preferred: 

Experience with Microsoft Office Previous Supervisory experience Previous Medical Billing experience Additional Information Schedule: Full-time Requisition ID: 25000102 Daily Work Times: Standard Business Hours Hours Per Pay Period: 80 On Call: No Weekends: No