Manager of Provider Credentialing

At USA Clinics Group, we use our expertise to provide the best possible service for our patients. Our team members are passionate about making a difference in the lives of the people we treat and are constantly striving to improve and better ourselves so that we can better support our patients and are currently searching for a Manager of Provider Credentialing to join our team!

As the Manager of Provider Credentialing you would be responsible for overseeing the credentialing and re-credentialing process for all providers in 170+ clinics across 30 states.

Responsibilities:

Processes physician accreditation, managed care, governmental and commercial insurance enrollment and re-credentialing

Responsible for daily provider data management and review of credentialing files for accuracy and completeness, utilizing internal and external sources

Responsible for analyzing clinic utilizations and develop physician location scheduling recommendations

Analyze local payor IPA markets for partnerships or payer contracting opportunities

Performs primary source verification via various state and national sources

Maintains individual provider credential files with all the appropriate documentation consistent with AAAHC and NCQA standards

Oversees, updates and maintains provider credential database including CAQH, PECOS, NPPES Registry, SharePoint any other applicable regulatory agencies

Develops and prepares analytical reports monthly/quarterly of the summary of credentialing activity

Responds timely to provider inquiries by letter, phone or internal communication

Work closely and maintain relationships with provider relations at each payer, and communicates any challenges and/or concerns with manager timely

Maintain Credentialing Applications for accuracy and completeness

Work to develop automation Bots to streamline the applications/Enrollment process

Additional duties as assigned

Requirements

Bachelor's degree preferred, Associates degree required

5-years experience with medical credentialing of physicians with various insurance companies, required

Negotiation of contracts and fee schedules experience, preferred

Familiarity with medical terminology through education or relevant work experience

Immaculate attention to detail and excellent proofreading skills

Strong Analytical and data manipulation skills

Excellent organizational skills