bizjobz LLC
Credentialing Manager (DMV Area) Position Description
Target Compensation: $83,000 - $93,000 ($40-$45 per hour)
Our client, a leading Orthopedic group with multi-state physician practices across the DMV region, is seeking an experienced Credentialing Manager. This is a critical leadership role reporting directly to the Director of Billing.
This position requires regular on-site presence during the first 90 days, after which it will transition to a hybrid/remote schedule.
Position Overview:
The Credentialing Manager oversees all aspects of provider credentialing, re-credentialing, expirable data management, and delegated credentialing contract processes. This includes managing applications, conducting primary source verifications, ensuring compliance with regulatory agencies, and leading a credentialing team in the daily execution of credentialing operations and database management.
Key Responsibilities:
Oversee the full credentialing lifecycle, including CAQH, payer enrollment, and provider onboarding documentation.
Develop, implement, and manage policies and procedures for credentialing and re-credentialing services.
Ensure compliance with accrediting and regulatory agencies; prepare reports required by managed care organizations and internal stakeholders.
Maintain and monitor the credentialing database, ensuring accuracy of data, reporting, and integration with downstream systems.
Manage the expirables process, ensuring provider licenses and certifications remain current with timely notifications.
Track and report credentialing turnaround times, focusing on accuracy, efficiency, and quality.
Provide on-site consultations and credentialing orientations to practices; deliver policy updates and training.
Lead credentialing audits in compliance with managed care delegated contracts.
Submit and maintain provider rosters with health plans; ensure accurate follow-up.
Supervise credentialing staff, oversee productivity, assign workloads, and ensure deadlines are met.
Work within the EHR to resolve credentialing-related account issues; escalate concerns when needed.
Coordinate provider recredentialing projects with healthcare plans and internal stakeholders; prepare reports for leadership.
Represent the organization with external partners, building and maintaining strong working relationships.
Prepare monthly credentialing activity reports for key stakeholders.
Support cross-training and provide backup coverage as needed.
Qualifications:
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Target Compensation: $83,000 - $93,000 ($40-$45 per hour)
Our client, a leading Orthopedic group with multi-state physician practices across the DMV region, is seeking an experienced Credentialing Manager. This is a critical leadership role reporting directly to the Director of Billing.
This position requires regular on-site presence during the first 90 days, after which it will transition to a hybrid/remote schedule.
Position Overview:
The Credentialing Manager oversees all aspects of provider credentialing, re-credentialing, expirable data management, and delegated credentialing contract processes. This includes managing applications, conducting primary source verifications, ensuring compliance with regulatory agencies, and leading a credentialing team in the daily execution of credentialing operations and database management.
Key Responsibilities:
Oversee the full credentialing lifecycle, including CAQH, payer enrollment, and provider onboarding documentation.
Develop, implement, and manage policies and procedures for credentialing and re-credentialing services.
Ensure compliance with accrediting and regulatory agencies; prepare reports required by managed care organizations and internal stakeholders.
Maintain and monitor the credentialing database, ensuring accuracy of data, reporting, and integration with downstream systems.
Manage the expirables process, ensuring provider licenses and certifications remain current with timely notifications.
Track and report credentialing turnaround times, focusing on accuracy, efficiency, and quality.
Provide on-site consultations and credentialing orientations to practices; deliver policy updates and training.
Lead credentialing audits in compliance with managed care delegated contracts.
Submit and maintain provider rosters with health plans; ensure accurate follow-up.
Supervise credentialing staff, oversee productivity, assign workloads, and ensure deadlines are met.
Work within the EHR to resolve credentialing-related account issues; escalate concerns when needed.
Coordinate provider recredentialing projects with healthcare plans and internal stakeholders; prepare reports for leadership.
Represent the organization with external partners, building and maintaining strong working relationships.
Prepare monthly credentialing activity reports for key stakeholders.
Support cross-training and provide backup coverage as needed.
Qualifications:
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