Credentialing Manager jobs in Canton, OH

Recently Added Credentialing Manager jobs

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NETWORK LIAISON 1 - CREDENTIALING
  • Aultman Health Foundation
  • CANTON, OH FULL_TIME
  • PURPOSE OF POSITION: The purpose of your position is to assist the department supervisor and with day to day operations within Networks, Credentialing and Contracting Departments. It is expected of the employee to develop, implement and maintain an accurate provider data base; analyze provider data, facilitate the preparation and follow-up of the monthly activities of the Membership Services Committee and PEER committee; track and report provider based information using Department databases; and serve as a communication link with Provider offices and other AultCare Departments regarding the status of providers. Other primary responsibilities include help with various compliance and accreditation standards that are constantly evolving throughout the department. Each person will be assigned a focus area of either membership or credentialing within the department. RESPONSIBILITES/DUTIES/EXPECTATIONS: Maintain a thorough knowledge and meet important industry standards set forth by organizations such as NCQA, CMS, ODI, QHP, CAQH, etc. Helps in coordinating updating of policies and procedures as necessary to comply with these standards. Consistently plans, organizes and completes tasks independently and thoroughly in the allotted time frames ensuring the departments# day to day work is completed (networks, credentialing and contracting). Subject to frequent interruptions, ability to be flexible when priorities change. Supports the day-to-day operations (networks, credentialing and contracting) by making appropriate recommendations to supervisor for changes within the Department, including process improvement and problem solving. Responsible for tracking and reporting own stats. Problem solve, handles difficult and sensitive issues with tact; exercises judgment where necessary and consults supervisor on major problems and issues. Team player, works across departmental lines while maintaining positive interactions with both internal and external customers. Prepare and post follow-up of the monthly activities of the Membership Services Committee and PEER committee (including but not limited to analyses, minutes, summaries, letters, etc.). Responsible for running queries and reporting. Analyze information to make meaningful recommendations to supervisor. Communicates regularly and appropriately with supervisor and co-workers and reports and accurately documents pertinent information. Maintains positive attitude and is cooperative in all duties. Communicates with providers, co-workers, and other health care professionals in a professional and respectful manner. Practices ethical conduct including, honesty, integrity, confidentiality and compliance with policies and procedures. Meets acceptable attendance and punctuality expectations (excluding FMLA). Seek supervisory guidance/approval as appropriate. Assist with orientation of new personnel into the department. Participate in quality review process of department. Ability to adapt to new software changes; maintain accuracy of current software, as well as, make suggestions/recommendations for continued streamlining of database and information. Promotes and demonstrates professional standards to enhance the development of the department including: portrays professional image, follows dress code, strong organization skills, strong computer skills, strong communication skills, actively seeks and pursues opportunities to make a contribution and demonstrates desire for learning. # The above statements reflect the general duties considered necessary to describe the principle functions of the job as identified and are not a detailed description of all the work requirements that may be inherent in this position. All qualified applicants will receive consideration for employment without regard to#race, color, religion, sex, age, national origin, disability, gender identity, sexual orientation or protected veteran status.# AultCare is an EEO/AA Employer M/F/Disability/Vet. AultCare/AHF will provide reasonable accommodations to employees or applicants with disabilities, as defined by the Americans with Disabilities Act, who are otherwise qualified to safely perform the essential functions of the job, with or without accommodation, unless such accommodation would constitute an undue hardship on AultCare/AHF or poses a direct threat to the health and safety of the individual or others that cannot be sufficiently mitigated by reasonable accommodation. Any applicant or employee who requires an accommodation to perform the essential functions of his or her job or to enjoy equal benefits and privileges of employment should notify the AultCare Human Resource Department and request such an accommodation.# # QUALIFICATIONS######### Education: High School diploma or GED required, college degree preferred, Experience will be considered. Evidence of varied responsibilities within previous work experience, ability to multi task. Maintains current State of Ohio driver#s license. Ability to prioritize and meet deadlines. Exceptional written and verbal communication skills. Must be organized. Strong knowledge of Microsoft Office, including Word, Excel, Access, Outlook and PowerPoint. # WORKING CONDITIONS Hours: Day Shift, Monday through Friday. Occasional extra hours may be necessary to meet deadlines.# Assists in special projects and performs other miscellaneous functions as required. Office environment with moderate noise level. Frequent sitting, use of hands/fingers across keyboard or mouse, and long periods working at a computer. Occasionally walking, standing, twisting/turning and reaching upward or forward during work day Use of own vehicle for provider site visits as necessary, mileage will be reimbursed.
  • 22 Days Ago
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R
Manager
  • Restaurant Enterprises Inc
  • Saint Clairsville, OH FULL_TIME
  • Manager:Competitive WageFull timeAs a manager you will assist the General Manager with the day-to-day operations of the restaurant. While working side by side with the crew you will assure great guest...
  • 1 Day Ago
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Z
Manager
  • Zepp's Pizza, LLC
  • North Canton, OH FULL_TIME
  • Overview: We are seeking a highly motivated and experienced Manager to join our team. As a Manager, you will be responsible for overseeing the daily operations of our restaurant. This is a leadership ...
  • 2 Days Ago
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O
Manager
  • Our Team
  • Canton, OH FULL_TIME
  • Role PurposeAssist in leading restaurant managers and team members in the execution of an excellent guest experience resulting in increasing guest counts, sales and MOP growth. Ensures decisions and a...
  • 26 Days Ago
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A
Manager
  • Arbys
  • Saint Clairsville, OH FULL_TIME
  • Manager:Competitive WageFull timeAs a manager you will assist the General Manager with the day-to-day operations of the restaurant. While working side by side with the crew you will assure great guest...
  • 1 Month Ago
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E
Assistant Manager
  • Englefield Inc
  • Uhrichsville, OH FULL_TIME
  • SUMMARY:The Assistant Manager is responsible for providing leadership and motivation of all site personnel and ensuring excellent customer service during assigned shifts. This position is responsible ...
  • 17 Days Ago
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0 Credentialing Manager jobs found in Canton, OH area

About Canton, Ohio

Canton (/ˈkæntən/) is a city in and the county seat of Stark County, Ohio, United States. Canton is located approximately 60 miles (97 km) south of Cleveland and 20 miles (32 km) south of Akron in Northeast Ohio. The city lies on the edge of Ohio's extensive Amish country, particularly in Holmes and Wayne counties to the city's west and southwest. Canton is the largest municipality in the Canton-Massillon, OH Metropolitan Statistical Area, which includes all of Stark and Carroll counties. As of the 2010 Census, the population was 73,007, making Canton eighth among Ohio cities in population. F...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Credentialing Manager jobs
$45,836 to $91,738
Canton, Ohio area prices
were up 1.3% from a year ago
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What does a Credentialing Manager do?

Credentialing Manager
Develops strong knowledge of the credentialing software, and full capabilities, to maximize its use and understands the functionality of the claims software, as it relates to the credentialing process.
September 07, 2022
Manage operations for the credentialing and recredentialing process to satisfactorily meet all standards as required by HMSA policies and procedures, state and federal regulatory requirements and all relevant accreditation standards pertaining to the credentialing for HMSA providers in all lines of business including commercial, Medicare, Medicaid and ACA products.
October 31, 2022
Prepares,reviews and submits credentialing applications as determined by state, federalor accrediting agency guidelines and standards for review, recommendations anddecision by the appropriate organizational committee or body.
November 22, 2022
Monitor Medicaid and Medicare sanctioning reports to ensure compliance with Health Care Financing Administration (HCFA) requirements regarding prohibition of excluded provider participation.
January 15, 2023
Maintains a thorough understanding of medical staff bylaws, Joint Commission standards, hospital organization and policies, medical staff rules and regulations, national practitioner data bank regulations and procedures, credentialing and privilege delineation procedures and medico-legal issues.
February 02, 2023
Assists in the development and implementation of medical record practices policies and procedures to ensure the timely, quality, and accurate delivery of medical record services.
March 23, 2023
Provides day to day supervision of site-specific medical record services and staff consistent with established policy and regulatory requirements, and statutes governing health information management practices.
April 03, 2023
Review and update departmental policies and procedures to ensure compliance with NCQA, CMS and other regulatory agencies.
April 26, 2023
Manages the processes of region-wide, complex information systems needs in project areas such as new business operating models, innovative approaches to IT solutions support, market research of emerging or available product functionality and operational readiness assessment.
May 10, 2023
Plans and directs program for orientation of new medical staff members to the hospital environment and duties and responsibilities of medical staff membership.
May 19, 2023