Credentialing Manager

PRIMARY ACCOUNTABILITY: Oversees the operations of the credentialing office to develop, manage and monitor processes and procedures that support the credentialing, re-credentialing, expirables data management, and insurance enrollment process for all MAHEC providers. Oversees all of the credentialing functions including application management and primary source verification. Ensures compliance with the appropriate accrediting and regulatory agencies. The Credentialing Manager will partner with internal teams, providers, facilities and payers to credential and privilege with organizations, and enroll providers with payers. This role will be responsible for managing the Credentialing, and Enrollment Team in internal and external credentialing and privileging, as well as, enrolling, and maintaining participation with governmental and commercial payers. SPECIFIC RESPONSIBILITIES: Manages the credentialing process for all MAHEC clinical providers, in accordance with, AAAHC NCQA, and HRSA accreditation standards, Federal and State laws, and MAHEC policies. Coordinates the management of the expirables process to ensure all clinical provider licenses and certificates remain current. Monitors and reports turnaround times for processing of credentials applications, with continued focus on delivery of a high quality product, with the greatest efficiency, in the least amount of time Maintain all required credentialing and privileging 100% of the time Deliver high quality service to the operations team and ensure providers are enrolled with payers appropriately and time. Measure and improve enrollment processes to minimize turnaround times Coordinates the management of the credentialing database ensuring accuracy of data Develops, recommends, and/or implements changes, revisions, and enhancements as appropriate to current operating environment. Effectively manage large amounts of information and documentation Manage department priorities to address business and operational goals and challenges Develop procedures and guidelines and ensure consistent department-wide implementation Report team statuses and team metrics to upper management Functions as primary credentials contact for all internal and external inquiries; develops and maintains positive working relationships. Run reports for weekly updates to management on enrollment and contracting statuses Comply with HIPAA and Corporate Compliance program policies and other applicable corporate and departmental policies. Lead regularly-scheduled staff meetings to communicate updates to team as necessary; manage payroll, time off, and performance concerns for direct reports; set and achieve team-specific departmental goals Performs other duties as assigned. KEY COMPETENCIES: Proficient presenting to and interacting with all levels of management Possess strong interpersonal skills in order to integrate and successfully function with all levels of the organization Extreme attention to detail, highly developed organizational skills, and ability to prioritize assignments Excellent communication skills: both verbally and in written text. Superior analytical and problem solving skills Self-directed with ability to work independently and manage time effectively In-depth knowledge of the various governmental and commercial payer requirements, contracts, applications, and workflow process Ability to research data and summarize key data points In-depth knowledge of CAQH, PECOS, and State Medicaid portals In-depth knowledge of state, governmental, and commercial payer regulations, policies, and procedures, and NCQH Standards Knowledge of related accreditation and certification requirement Ability to identify and redesign inefficient workflows and processes; offer guidance and quality decisions. Ability to process computer data and to format and generate reports. Positive and professional attitude, with a strong emphasis on working as a team. Perform quality work within deadlines LEADERSHIP COMPETENCIES: Vision and Strategic Thinking Builds a shared inspirational vision. Formulates effective strategies to achieve that vision. Influences others to translate that vision into action. Service Motivation Promotes an organizational culture that encourages providing the highest quality of service. Organizational Awareness Displays clear understanding of intra‐organizational dynamics. Establishes productive relationships with colleagues, senior leadership, government officials, community physicians and leaders, private contractors, foundations and other funders. Curiosity and Innovation Nurtures curiosity, continuous improvement and innovation. Generates and applies innovative solutions. Integrity and Accountability Instills trust through own actions and follows through on commitments. Exemplifies conduct congruent with MAHEC values. Resilience and Adaptability Deals effectively with pressure while maintaining focus and remaining optimistic under adversity. Is open to change, adapting rapidly in response to changing conditions and unexpected difficulties. Leadership Presence Displays poise, confidence and authenticity. Commands respect from colleagues. Confronts difficult issues despite personal discomfort or risk while maintaining a professional and respectful attitude. Agility Deals comfortably with ambiguity and complexity. Diversity, Inclusion Equity Seeks out cross-cultural experiences that encourage awareness; seeks feedback from diverse stakeholders. Ensures equity mindset to carry out mission in culturally relevant ways. Quality and Process Improvement Drives for continuous improvement. Works with the team to identify ways to streamline and improve efficiency of work and service delivery. Ensures that defined processes, quality standards, and best practices are adopted swiftly and updated regularly. Technical Solutions Orientation Possesses a depth of knowledge and skill in required technical areas. Develops technical solutions to new or highly complex problems that cannot be solved using existing methods or approaches. Expertise is highly sought out to provide advice or solutions. Stays informed about cutting-edge technology as a critical key to success. EDUCATION and/or EXPERIENCE: • Bachelor's degree in Healthcare or Business Administration, Finance, Accounting, or a related field, or an equivalent combination of years of education and experience. • Minimum of five (5) years of related experience required • Minimum of three (3) years of management experience required CERTIFICATES, LICENSES, REGISTRATIONS: • CPCS preferred COMPUTER SKILLS: • Strong computer literacy required including proficiency in relevant software including, Microsoft Office (Excel, PowerPoint, and Word; Access a plus). Throughout the COVID-19 pandemic, MAHEC has worked tirelessly to promote evidence-based practices across our entire organization. With this in mind, all MAHEC employees and learners will be required to receive the COVID-19 vaccine or have an approved exemption (for employees only). MAHEC Talent Management is located at 121 Hendersonville Road, Asheville, NC 28803. Equal Opportunity Employer. Black, Indigenous, People of Color and Spanish/English bilingual persons are strongly encouraged to apply. MAHEC is a certified Living Wage employer through Just Economics of Western North Carolina. We offer excellent benefits and are committed to creating a diverse, inclusive, and equitable workplace. SALARY: Starting compensation for this position is $59,200 annually and offer is based on experience, educational requirements and internal team equity.