Title: Credentialing Manager
Job Summary: In accordance with Omni Family Health (OFH) Policies and Procedures, this position is a key part of the Management team for OFH. The Manager is responsible for the coordination and responsible duties of the department, supervision of the Credentialing Specialist and other personnel within the department, and ensuring compliance with the credentialing/privileging process internally and externally with Plans and Programs. This position reports to the Director of Managed Care.
- Functions as part of a team in the provision of credentialing and privileging of practitioners, allied staff and other licensed personnel.
- Provides technical assistance for department staff and OFH staff as required.
- As a manager, is responsible for recruitment, orientation, evaluation, training, skill assessment and counseling of department employees. Completes employee performance appraisals and counseling if applicable.
- On-going identification of potential issues and/or concerns, as well as opportunities within the Credentialing Dpt.
- Participates with outside agencies that relate to the Credentialing process, such as ICE (Industry Collaboration Effort), CAMMS (California Association Medical Staff Services), and health plans.
- Oversees and participates in credentialing meetings.
- Maintaining compliance with regulatory and accrediting bodies; Joint Commission, NCQA and HRSA/FTCA credentialing requirements.
- Responsible for ensuring Medicare, Medi-Cal, Special Programs and CAQH clinic applications, including Pharmacy are completed accurately and submitted in an efficient and timely manner.
- Knowledgeable and efficient in submitting applications through PAVE and PECOS websites.
- Developing and implementing credentialing/privileging processes and procedures;
- Developing and implementing provider enrollment processes and procedures for health plans;
- Develop electronic file keeping and data management systems.
- May assist providers and/or department staff in completing credentialing applications and necessary paperwork.
- Collaborates with inter-departmental peers, including Quality Management, Operations, Human Resources, and Medical to identify and implement best practices and to ensure an integrated, timely and consistent product.
- Communicates with all OFH staff verbally, email, memo or phone as appropriate.
- Ability to work cooperatively in a team environment to support and advance the mission, vision and goals of Omni Family Health.
- Performs other duties as assigned or required.
- HIPAA compliance - Responsible for maintaining abreast of and in compliance with all regulations and requirements as defined under the Health Insurance Portability and Accountability Act (HIPAA). Is expected to treat all OFH team member’s information as sensitive and confidential.
- Compliance - Ensure compliance with all local, state and federal regulations.\
- All employees will participate in Patient Centered Health Home Model at Omni Family Health.
- QA/QI - Participate in QA/QI activities and contribute towards the overall performance improvement of the organization.
- Promotes Omni Family Health mission statement, ethics and values through communication, action, and behavior. Expected to demonstrate awareness of, and compliance with, organizational objectives of OFH in providing quality health care access services for all members of the community.
Qualifications, Experience, and Education:
EDUCATION: Bachelor’s degree or eight years of healthcare administration experience required. Certified Provider Credentialing Specialist or Certified Professional Medical Services Management certification preferred.
EXPERIENCE: Two (2) years of credentialing experience in healthcare with a thorough understanding of credentialing and privileging. Minimum five (5) years' experience working in a healthcare setting with project management and supervisory responsibilities. Managed care experience is preferred.
- Specific knowledge, experience, and demonstrated ability in areas of credentialing, management, supervision and management of personnel, communication and leadership skills is expected.
- Proficient with computers systems, networks and software applications (MS Word, Excel) as word processors and spreadsheets required. Ability to learn and adapt to technology innovations newly introduced to the work environment.
- Knowledge of office procedures and familiarity with using general office equipment (e.g., copiers, scanners, fax, etc.)
- Be committed to providing superior customer attention and service at all times at every point of human contact. Ability to anticipate the needs of the customer and deliver on expectations consistently.
- Ability to communicate effectively in conveying information and/or ideas across all modes of communication (e.g., email, letter writing, telephone conversations, etc.) to internal and external customers.
- Ability to organize and approach work independently to meet deadlines and possess time management skills.
- Ability to work quickly and accurately and balance work load against shifting priorities and do so while maintaining a positive outlook and approach.
Responsible to: Director of Managed Care
Classification: Exempt position, full-time
Omni Family Health
Why Work Here?
Omni Family Health is a dynamic and growing non-profit organization consisting over 30 of state of the art health centers.