Credentialing Manager
Credentialing Manager
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USD 70000 - 80000
1 Vacancy
Job Description
Job Summary:
The Credentialing Manager will oversee and manage the credentialing and re-credentialing
processes for all physicians healthcare providers and allied health professionals at the Los
Angeles Center for Ear Nose Throat and Allergy (LACENTA). The role will ensure
compliance with federal state and regulatory requirements while maintaining high standards for
quality and efficiency. The Credentialing Manager will be a key part of the operations team and
collaborate closely with clinical staff administrative departments and regulatory bodies to
facilitate the smooth onboarding of healthcare providers.
Job Duties and Responsibilities:
Credentialing Process Management
Oversee and coordinate the credentialing and re-credentialing process for all physicians
and healthcare professionals ensuring timely submissions to health insurance companies
hospital privileges and regulatory agencies.
Compliance
Ensure all credentialing practices comply with relevant federal state and insurance
regulations (e.g. CMS NCQA JCAHO etc.). Monitor changes in regulations and apply
them to the credentialing processes as needed.
Provider Database Management
Maintain and manage an up-to-date provider database ensuring accurate records of
licensure certifications malpractice insurance and education. Regularly audit files to
confirm adherence to accreditation standards.
Documentation and Reporting
Prepare and submit credentialing packets to insurance companies and other relevant
parties. Maintain accurate and complete records of credentialing files for all providers.
Insurance Contracting
Act as a liaison between the organization and insurance payers to ensure all credentialing
information is up-to-date and providers are appropriately listed in insurance networks.
Assist in managing the enrollment of new providers with health insurance plans.
Staff Training and Development
Provide ongoing training for administrative and clinical staff on credentialing processes
documentation and compliance requirements.
Problem Resolution
Act as the primary point of contact for providers and insurance companies with questions
regarding credentialing status. Troubleshoot and resolve issues in a timely manner.
Collaboration
Work closely with HR legal and clinical departments to ensure that all providers meet
the necessary standards and are in good standing for employment. Assist with onboarding
new hires ensuring all credentialing paperwork is complete before provider start dates.
Qualifications and Experience:
To perform this job successfully an individual must be able to perform each essential duty
satisfactorily. The requirements listed below are reflective of the knowledge skill and/or ability
required.
Education
Bachelors degree in healthcare administration business or a related field (or equivalent
work experience).
Experience
Minimum of 2 years of credentialing experience in a healthcare environment with a
strong background in managing physician credentialing preferably in a multi-specialty
setting.
Certifications
Certification in healthcare credentialing (e.g. CPCS or CPMSM) preferred.
Knowledge and Skills
In-depth knowledge of healthcare regulations including CMS HIPAA and
insurance credentialing requirements.
Strong organizational and communication skills.
Proficiency in Microsoft Office Suite (Word Excel Outlook).
Experience with credentialing software (e.g. Echo Verity etc.) is preferred.
Strong attention to detail and ability to manage multiple tasks with competing
deadlines.
Personal Attributes
Self-motivated proactive and able to work independently.
Strong problem-solving skills and a team-oriented attitude.
High level of confidentiality and professionalism.
Physical Demands:
The physical demands described here are representative of those that must be met by an
employee to successfully perform the essential functions of this job. Individual will be required
to:
Sit for long periods at a time.
Use hands and fingers in repetitive motions daily.
Ability to lift push pull up to 20 lbs. periodically.
Travel to clinic locations or sites as needed.
Reasonable accommodations may be made to enable individuals with disabilities to
perform the essential functions.
Required Experience:
Manager
Employment Type
Full-Time
