Manager, Credentialling Position Available In Burlington, New Jersey

Manager, Credentialling CareAbout Health Evesham, NJ 08053 • Remote Evesham, New Jersey 08053 Company Description CareAbout Health is a managed services organization (MSO) that provides expert advice, resources, tools, and other support to its portfolio of medical groups and healthcare focused companies. CareAbout Health is helping align incentives to create a world where patients, providers, and payers work together in a seamless, coordinated manner toward common goals: higher quality, lower cost, better outcomes.

Role Title:

Credentialing Operations Manager Role Location:

Remote Reporting Relationships:

This position reports to the

Director of Credentialing Role Summary and Responsibilities:

The credentialing manager is responsible for leading the credentialing team to ensure compliant and efficient provider processing in accordance with all applicable laws, payor contracts, and delegated credentialing standards. Key Responsibilities /

Essential Functions:

Understand and comply with all payors and state regulations/standards/laws related to all credentialing, provider data management, and payer enrollment activities Support Director in managing all provider credentialing activities in accordance with NCQA and payer standards for delegated and non-delegated relationships Follow standard operating procedures in accordance with all contractual and regulatory requirements Management and training of credentialing team Represent on Payer meetings as needed Internal and external liaison for issue resolution Facilitate malpractice applications, policy management, and Certificate of Insurance distribution for providers and PLLC Responsible for: CAQH profiles of the group and providers Provider rosters internally and at payor level Facilitation on hospital affiliation request and renewals for physicians Master provider and location rosters Manage communications across internal teams Meet or exceed in quality, performance, financial, and operational targets as established by leadership Improve the processes/workflows and performance of the credentialing team Develop, interpret, and execute functional objectives Coordinates the processing, distribution, and management of all credentialing and accreditation documents for affected providers. Maintain accuracy and completeness of credentialing database. Maintain and track provider licensure, requesting current version from appropriate parties when necessary. Review payer plan applications returned to department for accuracy and completeness and reprocessing of same. Assist in ensuring that provider participation in the payer plans and CAQH is current, accurate and up to date. Maintains and ensures strict confidentiality of files and databases.

Non-Essential Functions:

Other duties, as assigned.

Qualifications:

Bachelor’s Degree required. 5+ years of management experience with at least 2 years managing a delegated credentialing team. Relevant practice and IPA credentialing experience .

Medicaid / Medicare

/ State and Managed Care Plan regulatory experience. Managed Care experience. Primary source verification experience.

Preferred Qualifications:

Network Management contracting experience. Demonstrated knowledge of the healthcare industry. Strong work ethic. Strong Instructional and interpersonal skills. Highly driven and ability to self-direct. Ability to work effectively with clinical leadership and site operations. Ability to communicate effectively in verbal and written forms. Ability to troubleshoot, problem solve and work as a team as well as independently. Ability to multi-task, prioritize workload to meet deadlines, and pay attention to detail.

Physical Requirements:

Mainly sedentary. Sitting at the desk most of the day. Standing or walking less than two hours per day. Lifting no more than ten pounds on rare occasions. Must be able to work at a computer and answer phone calls on a regular basis. The compensation range for this position is $59K/yr. – $88K/yr.

Featured Benefits:

Health, dental, and vision insurance. 401K with automatic employer contribution. PTO and Paid Holidays. Company paid Life Insurance. Access to voluntary short and long-term disability insurance. Access to additional life insurance. Access to a variety of Wellness programs. CareAbout Health is committed to providing an environment of mutual respect where equal opportunities are available to all applicants and employees without regard to actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth, related medical conditions and lactation), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, disability, protected medical condition as defined by applicable state or local law, genetic information, or any other characteristic protected by applicable federal, state, or local laws and ordinances (referred to as “protected characteristics”). We are interested in every qualified candidate who is legally able to work in the United States without sponsorship. We cannot offer any visa sponsorship now at this time. Compensation is based on the level and requirements of the role. Salary within our ranges may also be determined by your education, experience, knowledge, skills, abilities, and location, as required by the role, as well as internal equity and alignment with market data.