Medical Staff Credentialing Manager jobs in District of Columbia

JOB DESCRIPTION:

Reporting to the Chief Operating Officer (COO), the Provider and Payer Credentialing Manager monitors the credential status of licensed and certified employees and contractors of Prestige Healthcare Resources (PHRI)and ensure they are operating within the scope of their licenses and certifications. The Provider and Payer Credentialing Manager also works with MCOs and insurances connected with PHRI to complete the process of empaneling credentialed and certified providers. 

DUTIES AND RESPONSIBILITIES

• Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications.
• Process initial credentialing and re-credentialing applications.
• Screen provider applications and supporting documentation to ascertain their eligibility.
• Implement policies and procedures to ensure that applications are properly verified and accurate.
• Partner with the HR department in onboarding and exiting credentialed employees in a timely manner.
• Matches required credentials to payer requirements.
• Works closely with Prestige leadership in the payer credentialing process to ensure adherence to contract terms and conditions.

QUALIFICATIONS

• Bachelor’s degree in healthcare administration, business. At least 10 years of experience in credentialing may be considered as a substitution.
• Highly organized and detail oriented.
• Demonstrated experience in behavioral health credentialing.
• Demonstrated experience in payer credentialing highly preferred.
• Excellent verbal and written communication skills.
• Experience with and comfort in developing a paperless credentialing system.
• Works well with highly confidential and sensitive material.
  • Builds positive relationships with employees and leadership through influence and thought partnership.
  • Analytical thinker, self-motivated.

LOCATION

Remote

PHYSICAL DEMANDS

General Office expectations

POSITION TYPE AND EXPECTED HOURS OF WORK

• Exempt
• Full-time

             TRAVEL

• Within the Washington, D.C Metro Are

Work Authorization/Security Clearance (if applicable)

• Authorized to work in the U.S.A./None

AAP/EEO STATEMENT

• It is the policy of Prestige Healthcare Resources, Inc. to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. In addition, Prestige Healthcare Resources, Inc. will provide reasonable accommodations for qualified individuals with disabilities.

Other Duties

• Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.