Credentialing Manager jobs in Council Bluffs, IA

REMOTE WORK OPPORTUNITY

Your time at work should be fulfilling. Rewarding. Inspiring. That’s what you’ll find when you join one of our non-profit CHI facilities across the nation. You’ll find challenging, rewarding work every day alongside people who have as much compassion as you. Join us and together we’ll create healthier, stronger communities.

CHI Health provides you with the same level of care you provide for others. We care about our employees’ well-being and offer benefits that complement work/life balance.

With you in mind, we offer the following benefits to support your work/life balance:

• Health/Dental/Vision Insurance 
• Direct Primary Plan (No copay, no deductible, and access to CHI Health provider 24/7)
• Premium Access to our Family Care Program supporting your needs for childcare, pet care, and/or adult dependent care
• Voluntary Protection: Group Accident, Critical Illness, and Identity Theft 
• Employee Assistance Program (EAP) for you and your family
• Paid Time Off (PTO) 
• Tuition Assistance for career growth and development
• Matching 401(k) and 457(b) Retirement Programs
• Adoption Assistance
• Wellness Programs
• Flexible spending accounts

From primary to specialty care as well as walk-in and virtual services CHI Health Clinic delivers more options and better access so you can spend time on what matters: being healthy. We offer more than 20 specialties and 100 convenient locations; with some clinics offering extended hours.

Responsibility for credentialing and re-credentialing of Physicians, Advanced Practice Clinicians, Ancillary Providers and Facilities. Ensures optimum utilization of the managed care credentialing process through proactive coordination and tracking of all information in the credentialing files of all providers in CHI Health Partners as well as being responsible and accountable for maintenance of credentialing related information. Presents with positive and cooperative image with internal and external customers and contacts.

ESSENTIAL KEY JOB RESPONSIBILITIES
1. Manages credentialing and re-credentialing process for CHI Health Partners (CHP).
2. Coordinates provider CHP packets and receipt of credentialing files from Med Staff Services.
3. Develop, update and coordinate the implementation of Credentialing policies and procedures for approval by the Clinical Integrated Network (CIN) and final approval CIN Board, as needed.
4. Ensures compliance and adherence to NCQA standards of function and responsibility relates to credentialing for CHP.
5. Works with provider offices and facilities to attain correct information.
6. Responsible for preforming verification by query to the National Practitioner Data Bank (NPDB),
Office of Inspector General (OIG), System for Award Management (SAM), Medicare Opt Out and State
Exclusions and Sanctions for Nebraska and Iowa.
7. Completes process of credentialing new providers by sending the welcome letter and contract. Runs new provider report to send to all managed care payer, recredentialed providers receive a letter
showing the file is up to date. This all happens after they have been approved by the CIN Council and Board.
8. Coordinates and prepares for payer audits of CHP credentialing files for those networks which
Delegate credentialing to CHP.

Required:

High School diploma or equivalent required Associates degree in business or related field or equivalent. Combination of academic and/or professional experience required. Candidates without an Associate’s Degree must possess 1-3 years related experience.

Preferred Qualifications:

Excellent research, verification skills and attention to detail. Ability to work with providers, office staff and hospital administrators. Proficient in word processing and excel spreadsheets. This individual must maintain strict confidentially, communicate effectively, and work independently