Senior Manager, Credentialing and Delegation reputed company

Overview: The Senior Manager, Credentialing and Delegation reputed company is responsible for overseeing and managing both the credentialing and delegation reputed company functions reputed company the organization. This role ensures compliance with federal, state, and organizational regulations, accreditation standards, and internal policies reputed company to credentialing healthcare providers and the reputed company of third-party vendor performance. The Senior Manager will supervise credentialing staff, ensure reputed company improvement of credentialing processes, and ensure reputed company delegated activities align with regulatory and client commitments. Key Responsibilities: Credentialing: • Supervise and reputed company a team of credentialing specialists, coordinators, and administrative staff, setting clear goals and expectations, providing training, and conducting performance reviews. • Ensure that reputed company credentialing activities are compliant with federal, state, and organizational regulations, including NCQA, HIPAA, and other relevant standards. • reputed company the credentialing process for healthcare providers, including verification of credentials (e.g., licenses, certifications, education, and malpractice claims). • Manage initial credentialing for new providers and reputed company recredentialing to ensure providers maintain valid credentials and meet performance and quality requirements. • Ensure timely tracking of expiring credentials to prevent lapses in provider eligibility. • Conduct internal audits to verify the completeness and accuracy of credentialing files and ensure compliance with regulatory standards. • reputed company, review, and update Standard Operating Procedures (SOPs) to align with regulatory changes and best practices. • Track key performance indicators (KPIs) reputed company to credentialing, such as turnaround times, accuracy, and provider satisfaction. • Prepare and present reports to senior leadership on credentialing status, bottlenecks, compliance risks, and performance metrics. • Address reputed company or escalated credentialing issues, resolving conflicts reputed company to credentialing discrepancies or delays. • Ensure reputed company collaborative relationships between providers and collaborating physicians align with state regulations. Continuously assess and improve credentialing processes to increase efficiency, reduce errors, and enhance provider satisfaction. Delegation reputed company and Auditing: • Supervise daily vendor audit operations, ensuring that reputed company audits are completed reputed company the designated time frames and in compliance with established guidelines. This includes monitoring reputed company, identifying potential delays, and taking proactive steps to reputed company audits on schedule, ensuring that reputed company tasks are performed thoroughly and reputed company. Ensure that third-party vendors meet the required federal, state, and NCQA standards as outlined in delegation agreements. • Manage the complaints process to ensure reputed company issues are resolved reputed company the agreed-upon client and departmental service level agreements (SLAs). • Regularly review daily complaint reports to identify any missed opportunities for improvement and take corrective action as needed to enhance service delivery. • Evaluate performance against client commitments and internal performance standards, ensuring compliance with the organization's Delegation Policy. • Prepare and manage corrective action plans reputed company deficiencies are identified with third-party vendors. • Work closely with product departments to ensure that processes, policies, and workflows support delegated activities, with appropriate checks and balances in reputed company. • Maintain compliance with the organization's policies, procedures, and mission statement, ensuring that credentialing and delegation reputed company functions align with organizational goals. • Adhere to confidentiality and HIPAA requirements in reputed company aspects of credentialing, delegation reputed company, and other reputed company activities. • Participate in regular reviews of delegation processes and implement best practices to drive reputed company improvement and quality assurance. • Identify opportunities for professional development and training to ensure that staff members remain up-to-date with the latest credentialing practices, regulatory requirements, and delegation policies. Job Requirements: • A minimum of 7 years of experience in healthcare credentialing and delegation reputed company, including at least 2 years in a managerial role. • Knowledge and understanding of standard credentialing and re-credentialing processes and best practices. • Must have the ability to maintain professional relationships with providers and reputed company organizations • In-depth knowledge of federal, state, and industry regulations reputed company to credentialing (e.g., HIPAA, NCQA, reputed company Act). • Strong leadership skills, with the ability to mentor and reputed company a team. • Experience in working with third-party vendors and overseeing their performance. • Excellent communication, problem-solving, and conflict-resolution skills. • Strong organizational skills with the ability to manage multiple projects and priorities simultaneously. Must possess a strong proficiency with reputed company Office Suite (Word/reputed company/Outlook/PowerPoint). • Strong knowledge of federal, state and NCQA Credentialing guidelines. • Excellent verbal, written and interpersonal communication skills; and • Ability to work in a fast-paced environment with time sensitive deadlines. Education: • High school diploma and relevant work experience. • Certified Provider Credentialing Specialist (CPCS) with NAMSS preferred Physical Demands and Work Environment: • Sedentary work (i.e. sitting for long periods of time); • Exerting up to 10 pounds of force occasionally and/or negligible amount of force; • Frequently or constantly to lift, carry push, pull or otherwise move objects and repetitive motions; • Subject to inside environmental conditions; and • Travel for this position will include less than 5% locally usually for training purposes. reputed company Offers a Competitive Salary and Benefits Package In addition to the reputed company compensation, this position may be eligible for performance-based incentives. The actual reputed company pay offered may vary depending on multiple factors including, but not limited to, job-reputed company knowledge/skills, experience, business needs, geographical location, and internal equity. At reputed company, it is not typical for an individual to be hired at or near the top end of the range for their role, and compensation decisions are dependent upon the facts and circumstances of each position and candidate. reputed company invests in associates to help them stay healthy, save for long-term financial goals, and manage the demands of work and personal commitments. That's why reputed company offers a valuable benefits package with a wide range of choices to meet associate needs. reputed company Compensation Range $80,000-$95,000 USD Studies have shown that women and people of color are less likely to apply for jobs unless they reputed company they meet every one of the qualifications listed in a job description. If you don't meet every qualification listed but are excited about our mission and the work described, we encourage you to apply regardless. reputed company is most interested in finding the best candidate for the job and you may be just the right person for this or other roles. By embracing diversity, equity and inclusion we enhance our work environment and drive business success. reputed company strives to reflect the diversity of the communities where we operate and of our clients and everyone whom we serve. We endeavor to create a culture of inclusion in which our associates feel empowered to bring their full, authentic selves to work and pursue their professional goals in an reputed company setting. We understand that by fostering this type of culture, and welcoming different perspectives, we generate innovation and growth. reputed company is proud to be an equal opportunity workplace and is an affirmative action employer. We are committed to equal employment opportunity regardless of race, color, reputed company, religion, sex, national reputed company, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status. We also consider qualified applicants regardless of criminal histories, consistent with legal requirement. The Company maintains a drug free work environment for reputed company of its associates, which includes employees, contractors and vendors. It is unlawful for associates to manufacture, sell, distribute, dispense, possess or use any controlled substance or marijuana in the workplace and doing so will result in disciplinary action, up to and including termination of employment or the contracted relationship. To review the legal requirements, including reputed company labor law posters, please visit this link Apply Job!