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Credentialing Manager Jobs in Puerto Rico (NOW HIRING)

US Department of the Treasury

Program Manager

Caguas, PR · On-site

$125K/yr

Specialized experience would include one year of substantive supervisory or program management ... You must show proof the education credentials have been deemed to be at least equivalent to that ...

US Department of the Treasury

Program Manager

Ponce, PR · On-site

$125K/yr

Specialized experience would include one year of substantive supervisory or program management ... You must show proof the education credentials have been deemed to be at least equivalent to that ...

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Credentialing Manager information

What is a credentialing manager?

Credentialing Managers are professionals responsible for overseeing the process of verifying the qualifications, licenses, and background of healthcare providers before they are allowed to work with patients or participate in insurance networks. They ensure that all providers meet regulatory and organizational standards, and maintain up-to-date records for compliance purposes. Credentialing Managers often work in hospitals, healthcare organizations, or insurance companies, collaborating with medical staff, administrators, and external agencies to manage and streamline the credentialing process.

What does a credentialing manager do?

A credentialing manager monitors the credential status of employees and ensuring they are recertified when necessary. As a credentialing manager, your job duties involve maintaining a database of employee certifications and renewal dates, confirming that employee credentials match the requirements of their job, and helping employees renew their credentials on time by finding test dates and locations. Credentialing managers are most commonly found in the health care industry. Qualifications to become a medical credentialing manager include a bachelor’s degree in human resources, business, or a related field, and industry experience.

What are the key skills and qualifications needed to thrive as a credentialing manager?

To thrive as a Credentialing Manager, you need thorough knowledge of healthcare credentialing processes, compliance standards, and experience with provider enrollment, often supported by a bachelor's degree in healthcare administration or a related field. Familiarity with credentialing software systems like CACTUS or Verity, and understanding of regulatory requirements such as NCQA or The Joint Commission, are typically expected. Attention to detail, strong organizational skills, and effective communication are standout soft skills for this position. These competencies ensure accurate and efficient management of provider credentials, minimize compliance risks, and maintain quality standards within healthcare organizations.

What are some common challenges a credentialing manager faces when maintaining compliance with changing regulations?

Credentialing Managers often encounter the challenge of staying updated with frequently changing industry regulations and payer requirements, which can vary by state and organization. Ensuring that all provider files are consistently accurate and compliant requires diligent monitoring, regular audits, and ongoing staff training. Additionally, coordinating with multiple departments and external agencies to gather necessary documentation while meeting tight deadlines can be demanding. Proactively implementing process improvements and leveraging credentialing software can help manage these complexities effectively.

What is the difference between Credentialing Manager vs Credentialing Specialist?

AspectCredentialing ManagerCredentialing Specialist
ResponsibilitiesOversees entire credentialing process, manages teams, develops policiesPerforms credentialing tasks, verifies credentials, maintains records
Required CredentialsTypically requires experience in healthcare administration, certifications like Certified Provider Credentialing Specialist (CPCS)Often requires similar certifications, entry to mid-level experience
Work EnvironmentManagement level, strategic planning, team supervisionOperational, detail-oriented, administrative tasks
Industry UsageUsed across healthcare organizations, hospitals, clinicsCommonly found in healthcare facilities, physician practices

The Credentialing Manager focuses on overseeing the entire credentialing process, managing teams, and developing policies, while the Credentialing Specialist handles day-to-day credential verification and record maintenance. Both roles require relevant certifications and healthcare industry experience, but the manager role involves more strategic oversight.

More about Credentialing Manager jobs

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Credentialing Manager jobs near you

Program Manager

US Department of the Treasury

Guaynabo, PR • On-site

$125K/yr

Full-time

Posted 17 days ago

U.S. Department Of The Treasury rating

8.2

Company rating: 8.2 out of 10

Based on 13 frontline employees who took The Breakroom Quiz

309th of 846 rated public administrative organizations

Job description

WHAT IS THE LARGE BUSINESS & INTERNATIONAL DIVISION? A description of the business units can be found at: https://www.jobs.irs.gov/about/who/business-divisions
  • Position(s) are to be filled in following area(s):
    • LBI - Director Treaty and Trans Pric Ops - Treaty & Transfer Pricing Operations (TTPO) and Transfer Pricing Practice (TPP)
REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILSQualifications:

Federal experience is not required. Experience may have been gained in the public sector, private sector or through Volunteer Service. One year of experience refers to full-time work; part-timework is considered on a prorated basis. To ensure full credit for your work experience, please indicate dates of employment by month/day/year, and indicate number of hours worked per week, on your resume.
SPECIALIZED EXPERIENCE IR-1: To be minimally qualified for this position you must have at least one (1) year of specialized experience equivalent to the next lower-level payband or GS grade in the normal line of progression.
Specialized experience would include one year of substantive supervisory or program management experience at the GS-13 or GS-14 level or equivalent level manager or comparable management or leadership experiences outside of Federal service. To be qualifying for this position your experience should be sufficient to demonstrate:

  • Experience applying budget and fiscal methods, financial management principles, or resource analysis techniques used to support tax administration programs, compliance activities, or organizational operations.
  • Experience working in the international tax law domain, such as applying tax principles related to Individual International Tax, Transfer Pricing, Business International Tax, Internal Revenue Code Chapter 3 (Withholding of Tax on Nonresident Aliens and Foreign Corporations), Chapter 4 (Taxes to Enforce Reporting on Certain Foreign Accounts), Chapter 61 (Information & Returns), and other complex international tax compliance issues.
  • Experience interpreting and applying the Internal Revenue Code, tax laws, regulations, rulings, procedures, tax treaties, and other guidance to analyze and resolve complex tax issues.
  • Experience applying examination techniques, auditing principles, and compliance procedures involving complex returns, large business entities, international transactions, or other tax administration matters.
  • Experience analyzing industry practices, regulatory provisions, and emerging trends to identify compliance issues and develop technically supported recommendations or resolutions.
AND
You must also meet the following requirement(s):
  • TIME AFTER COMPETITIVE APPOINTMENT (TACA): By the closing date (or if this is an open continuous announcement, by the cut-off date) specified in this job announcement, current civilian employees must have completed at least 90 days of federal civilian service since their latest non-temporary appointment from a competitive referral certificate, known as time after competitive appointment. For this requirement, a competitive appointment is one where you applied to and were appointed from an announcement open to "All US Citizens".

For more information on qualifications please refer to OPM's Qualifications Standards.
Go to Understanding the IRS Paybands for GS/IR conversion.

Education:A college or university degree generally must be from an accredited (or pre-accredited) college or university recognized by the U.S. Department of Education. For a list of schools which meet these criteria, please refer to Department of Education Accreditation page.
FOREIGN EDUCATION: Education completed in foreign colleges or universities may be used to meet the requirements. You must show proof the education credentials have been deemed to be at least equivalent to that gained in conventional U.S. education program. It is your responsibility to provide such evidence when applying. Click here (Section 3, Explanation of Terms) or here for Foreign Education Credentialing instructions.
We recommend choosing an evaluator from a member organization of one of the following national associations of credential evaluation services: National Association of Credential Evaluation Services (NACES) or Association of International Credentials Evaluators (AICE).Employment Type: OTHER

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