Credentialing Manager jobs in Huntington, WV

Qualifications

Bachelor’s Degree in Business Administration or a human services related field with a strong working knowledge of state and federal regulations, Medicaid billing, managed care/prior authorizations, credentialing/licensing requirements, and an understanding of basic finance and/or accounting principles, with 3-5 years’ experience.

Proficient in Microsoft Office (Word & Excel) or similar software.

Must be a motivated individual with a positive and exceptional work ethic.

Ability to work independently with strong time management skills including planning, organization, multi-tasking, and ability to prioritize as required.

Highly organized, proficient in tracking deadlines and target dates

Strong attention to detail and accuracy

Must demonstrate effective communication skills both verbally and written.

Job Duties:

Gather credentials and re-credentialing materials for contracted and full-time clinicians.

Review and analyze clinician applications and reapplications, and accompanying documents, ensuring clinician eligibility.

Processes clinician accreditation, managed care, governmental and commercial insurance enrollment and re-credentialing.

Responsible for daily provider data management and review of credentialing files for accuracy and completeness, utilizing internal and external sources.

Perform primary source verification via various state and national sources.

Maintain individual provider credential files with all the appropriate documentation consistent with AAAHC and NCQA standards.

Oversee, update and maintain provider credential database such as CAQH, PECOS, NPPES Registry, or other applicable regulatory agencies.

Responds timely to provider inquiries by letter, phone, fax, secure email or internal communication.

Work closely and maintain relationships with provider relations at each payer and communicate any challenges and/or concerns with management.

Develop and prepare analytical reports as needed to analyze compliance, enrollment trends, clinician standings, contract dates etc.

Identify and resolve credentialing issues through reporting.

Review, and update, if necessary, health plan directories, agencies, and other appropriate entities for current and accurate provider information.

Additional duties as assigned.

Job Type: Full-time

Pay: $51,542.00 - $59,758.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Free parking
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift

Work Location: In person