Manager, Credentialing

We are searching for a Manager of Credentialing — someone who works well in a fast-paced setting. In this position, you will help curate a comprehensive HMO network of participating providers by implementing and overseeing effective and high quality credentialing processes and the training and development of the team's staff. You are also responsible for ensuring regulatory compliance with Texas Department of Insurance (TDI) and the Health and Human Services Commission (HHSC) on all matters pertaining to credentialing and preparing corrective action plans when deficiencies exist.

Think you’ve got what it takes?

Job Duties & Responsibilities
•    Compile and review documentation required by credentialing committee within established departmental and regulatory compliant timeframes.
•    Assist in the resolution of the most complex provider credentialing, re-credentialing, compliance and accreditation issues
•    Collaborate with other departments to ensure providers are contracted with and enrolled within established departmental and regulatory compliant timeframes
•    Regularly evaluate credentialing team’s efficiency, effectiveness and quality at credentialing and re-credentialing providers against established departmental and regulatory compliant requirements and proposes solutions if team is not meeting objectives
•    Demonstrate proficiency with TDI and HHSC regulations and NCQA requirements relating to credentialing
•    Prepare and present reports to leadership regarding the staff’s productivity, work quality and accuracy and make recommendations for process improvements and/or resources estimates
•    Escalate appropriate credentialing issues and concerns, as well as offering analysis and solution recommendations, to leadership in a timely and effective manner

Skills & Requirements
•    High School Diploma or GED Required
•    Bachelor's Degree in Related Field Preferred
•    Prior management or supervisory experience
•    7 Years Provider Credentialing Experience in a Managed Care, Health Plan Or Health Provider Setting Required
 

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