Credentialing Manager

This is a fully remote position, open to applicants in Ohio.

📋 Description

• Supervise all activities related to provider credentialing, recredentialing, payer enrollment, and provider maintenance for ISBH.

• Lead the credentialing team and manage daily operations to ensure the prompt completion of credentialing tasks.

• Accountable for performance management, recruitment, onboarding, and team development, including implementing progressive discipline when necessary.

• Guarantee the timely submission, tracking, and follow-up of credentialing and recredentialing applications to avoid lapses in provider participation.

• Maintain provider credentialing files and databases, ensuring that all licenses, certifications, registrations, and other required documents are up to date.

• Track provider enrollment status with Ohio Medicaid, Medicare, commercial payers, and other contracted entities.

• Act as the primary point of contact for resolving intricate credentialing and payer enrollment challenges.

• Ensure adherence to federal, state, accreditation, and payer-specific credentialing standards.

• Create, implement, and uphold credentialing policies, procedures, and quality assurance benchmarks.

• Analyze credentialing performance metrics and identify areas for process enhancement and operational efficiency.

• Collaborate with billing, compliance, human resources, clinical leadership, and provider relations teams to support organizational objectives.

• Maintain a strong understanding of credentialing regulations, payer requirements, provider enrollment procedures, and industry best practices.

• Coordinate credentialing tasks related to new programs, services, locations, and revenue streams.

• Engage in audits, accreditation reviews, and compliance activities as needed.

• Attend virtual and in-person internal and external training sessions, conferences, and meetings as appropriate.

• Ensure compliance with HIPAA, mandated reporting obligations, and professional ethical standards.

• Travel within the designated service area as required.

• Perform additional duties as assigned.

⛳️ Requirements

• A high school diploma or GED equivalent is mandatory.

• A bachelor's degree in business, Public Health, Healthcare Administration, or a related field is preferred.

• A minimum of 5 years of experience in provider credentialing and payer enrollment within a healthcare environment is required.

• At least 3 years of supervisory or management experience in a healthcare credentialing position is necessary.

• Experience with Ohio Medicaid provider enrollment and credentialing is essential.

• Proficiency in working with credentialing systems and electronic health records is required.

• Familiarity with NPPES, CAQH, Ohio Medicaid PNM, and payer enrollment portals is required.

• Knowledge of credentialing standards, provider enrollment criteria, and healthcare regulatory compliance is important.

• Ability to independently manage multiple projects, deadlines, and priorities.

• Strong analytical, organizational, and problem-solving skills are essential.

• Proficient in databases, spreadsheets, and Microsoft Office applications.

• Excellent communication skills, both verbal and written, are required.

• Strong organizational skills are necessary.

• Understanding of local, state, and federal regulations is required.

• Ability to maintain confidentiality is essential.

• A valid driver's license and the ability to operate a motor vehicle are required.

• A suitable level of auto insurance coverage is necessary.

• Capacity to meet deadlines in a fast-paced, high-volume environment is essential.

• Ability to operate in an Internet-based, automated office setting is required.

• A high-speed internet connection is necessary.

🏝️ Benefits

• Medical

• Dental

• Vision

• Short-term Disability

• Long-term Disability

• 401K with Employer Match

• Employee Assistance Program (EAP) providing support and resources for a variety of issues for you and your family.