Credentialing Manager

GENERAL SUMMARY:

Responsible for overseeing all aspects of credentialing and re-credentialing of health care servicing and billing professionals with payers and medical facilities. Through daily oversight this position will ensure the following: initial securing and renewals of state licensures, federal DEA licensures, and state CSN (controlled substance number) certificates. Responsible for initial appointment and re-appointment to healthcare facilities, initial payer enrollments and renewals, maintaining integrity of organization's provider centralized database, and accumulating and monitoring professional's CMEs required for licensure. In addition, develops Credentialing Specialists to perform as the point of contact and liaison for revenue cycle staff related to payers, vendors, external clients, and facilities related to credentialing issues.

PRINCIPAL JOB FUNCTIONS:

1. *Commits to the mission, vision, beliefs and consistently demonstrates our core values.

2. *Oversees the departmental budgetary procedure to ensure proper operational and capital planning, appropriate and efficient use of resources, and consistent compliance to budgetary and fiscal controls.

3. *Responsible for hiring, training, supervising, coaching, mentoring, retaining and evaluating of staff.

4. *Oversees the Credentialing Specialist Team responsibilities to include securing initial state licensure and maintenance of state licensure for applicable Physicians and advanced practice providers (APPs) and securing

initial and maintenance of state applicable federal DEA registrations and state controlled substance numbers for applicable Physicians and APPs.

5. *Facilitates the initial medical staff appointment and reappointment application process for Physicians and APPs at Bryan Medical Center, additional Bryan Health medical facilities and non-Bryan Health critical access and regional hospitals as needed.

6. Communicates and routes information timely for completion/signature to Physicians and APPs to complete the credentialing/payer enrollment/medical staff appointment-reappointment process.

7. Initiates and facilitates the payer enrollment process for new Physicians and APP's and re-enrollment of Physicians and APPs with government and contracted payers/insurance companies via payer portals or CAQH.

8. Maintains centralized database of all provider licensure/registrations/payer enrollments/medical staff appointments as approved by Director.

9. Maintains and tracks physician continuing medical education hours required for applicable state licensures in a centralized database.

10. Acts as point person/liaison for revenue cycle staff, payers, vendors, and external clients/facilities related to any credentialing duties/requirements/needs/discrepancies.

11. *Maintains strict confidentiality of personal information/legal information/practice history information of Physicians/APP's.

12. *Ensures all Credentialing Specialists are cross trained to support credentialing operations.

13. *Assists Corporate Compliance Department with requests specific to regulatory reporting (Open Payments, etc.).

14. *Helps and supports Credentialing Specialists to ensure timely completion of daily tasks.

15. Resolves problems and issues independently using sound judgement and following established departmental guidelines in a timely manner and escalates to Director when necessary.

16. Continuously seeks opportunities to improve efficiencies specific to workflows (software/hardware/PDSA's)

17. Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.

18. Participates in meetings, committees and department projects as assigned.

19. Performs other related projects and duties as assigned.

(Essential Job functions are marked with an asterisk "*". Refer to the Job Description Guide for the definition of essential and non-essential job functions.) Attach Addendum for positions with slightly different roles or work-specific differences as needed.

REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:

1. Knowledge of Nebraska, Federal and external state licensure/registration requirements/guidelines.

2. Knowledge of DEA registration process and requirements.

3. Knowledge of the professional services revenue cycle.

4. Knowledge of computer hardware equipment and software applications relevant to work functions.

5. Knowledge of organizational and human resource management standards and practices.

6. Knowledge of performance improvement, budgetary and financial methods and practices.

7. Knowledge of management and leadership principles and practices.

8. Skill in conflict diffusion and resolution.

9. Ability to communicate effectively both verbally and in writing.

10. Ability to perform crucial conversations with desired outcomes.

11. Ability to establish and maintain effective working relationships with all levels of personnel and medical staff.

12. Ability to problem solve and engage independent critical thinking skills.

13. Ability to perform crucial conversations with desired outcomes.

14. Ability to make operational and management decisions in response to changing conditions.

15. Ability to maintain confidentiality relevant to sensitive information.

16. Ability to prioritize work demands and work with minimal supervision.

17. Ability to maintain regular and punctual attendance

EDUCATION AND EXPERIENCE:

Bachelor's degree required. Minimum of two (2) years supervisory or management experience required. Minimum of six (6) months credentialing experience or one (1) year healthcare experience (within Revenue Cycle ideal) preferred.