Credentialing Manager

Jersey City, NJ

Posted: 08/21/2018 Job Number: 11490364
ProMed Staffing Resources is seeking a Credentialing Manager for a company in Jersey City.
Position Summary: The Credentialing Manager will be responsible for enrollment, credentialing and re-credentialing of all providers for professional services.  In this role the successful candidate will spearhead the operations of credentialing services being offered by our organization and be in a pivotal role to communicate to our clients and providers alike.  
Essential Job Functions:
• Thorough knowledge and proficiency in all aspects of provider enrollment in a professional healthcare practice setting.
• Understanding of credentialing processes as it relates to medical billing including Electronic Remittances, Service Locations and other details that could impact reimbursement.   Communication to Sr. VP of Operations on all credentialing issues that may impact billing operations.
• Primary source verification for resolves issues concerning provider' s enrollment with insurance companies. 
• Ensures timely completion of credentialing and re-credentialing of providers for all insurance carriers.
• Thorough knowledge and effectiveness in insurance portals including CAQH.
• Obtains appropriate credentials as well as updated copies prior to the expiration date of any license, certification, or other required document.
• Acts as liaison with Practitioners, billing management and insurance carriers.
• Maintains internal files including copies of current credentials and load/scan all documents into credentialing database.
• Maintain up to date and credentialing status in database.  Generate routine reports in the database and sends to client.
Required Qualifications:
• Previous supervisory or management experience in the healthcare setting.
• 7+ years of applicable experience in credentialing in a professional practice.  Multi-specialty experience is a big plus.
• Excellent written and verbal communication skills with superior attention to detail.
• Ability to multi-task under tight timelines with strong administrative and exceptional organizational skills.
• Advanced knowledge of Microsoft Excel and knowledge of credentialing databases or reporting systems.
Salary: 65K-75K + DOE

 
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