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Manager, Credentialing

People's Health Centers | St. Louis, MO | Full Time

Job Description

About Us:

Betty Jean Kerr People’s Health Centers (PHC), founded in 1972, has been in the forefront in the provision of quality health care to the St. Louis metropolitan area for over 40 years. PHC, through its mission, provides comprehensive primary healthcare, such as Pediatrics, Internal Medicine, OB/GYN, Dental, WIC, Mammography, Behavioral Health, Pharmacy, Radiology, Podiatry and laboratory services, to meet the health needs of the entire community. With its three (3) conveniently located health centers, and its friendly and welcoming staff, PHC aspires to serve all the health and wellness needs of the entire family.

Position Summary

The Credentialing Manager will manage, oversee, supervise, and direct the day to day operations of clinical staff credentialing for Betty Jean Kerr People’s Health Centers and Amanda Luckett Murphy Hopewell Center. In addition the manager will manage and oversee the provider enrollment process for clinical staff who bill with the organizations’ contracted payers and hospitals. Requires a strong understanding of guidelines and compliance with regulatory and accreditation agencies for the clinical staffing of Federally Qualified Health Centers and Community Mental Health Centers. Credentialing and privileging oversight includes the initial credentialing and privileging of incoming providers and the re-credentialing of existing providers.  Requires management of subordinate staff in the day-to-day performance of their jobs.


Duties and Responsibilities

•Direct report to the Chief Medical Officer.

•Supervises, trains, coaches, and manages Credentialing Department staff in the day to day performance of their job.

•Responsible for annual staff performance appraisals of Credentialing staff.

•Responsible for Department recordkeeping, forms creation, and policies & procedures.

•Monitors the credentialing status of clinical staff and ensures they are re-credentialed when necessary.

•Analyzes and reports trends in the application and credentialing status.

•Ensures Department goals are met.

•Displays extension knowledge of Credentialing Department processes.

•Oversees the credentialing and privileging processes for the organizations.

•Oversees the provider enrollment and hospital privileging applications for organizational providers who bill and                  require hospital privileges.

•Implements policies and procedures to ensure that credentialing is properly processed.

•For PHC presents files to the Clinical Standards Committee.

•For PHC sends monthly notices and IT emails to add new staff to NexGen.

•Ensures compliance with regulatory and oversight bodies for Federally Qualified Health Centers and Community                Mental Health Centers.

•Ensures compliance with accreditation requirements through proper credentialing for both existing and incoming                clinical staff.

•Develops and implements policies, protocols, and forms related to credentialing, privileging, and provider                            enrollment.

•Responsible for all aspects of the verification process for credentialing and privileging.

•Provides highly skilled liaison representation support with internal and external customers. 

•Provides direction and training to staff to ensure departmental compliance with established productivity and quality            standards.

•Provide clear and effective communication with Executive Management Team, other department managers, hospital          CVO and Medical Staff Services, contracted payers, and other contacts.

•Coordinates with the providers, provider partners, management, and other related parties to facilitate the                            credentialing process.

•Develop a daily management system to monitor standard work, quality, and production.

•Supervise and manage resources used for processing credentialing and re-credentialing.

•Lead credentialing QAPI subcommittee meetings on a quarterly basis.

•Maintain and update Credentialing Policies and Procedures.

•Maintain strict confidentiality in handling the credentialing documents and processes.

•Manage and maintain provider and facility records necessary to keep track the credentialing, re-credentialing, and              other compliance requirements.

•Respond to inquiries from providers, management, health plans, and other parties regarding credentialing for                      providers.

•Serves as the primary point of contact for all credentialing inquiries for both internal and external parties.

•Serves as organizational contact for credentialing audits with affiliated organizations.

•Other duties as assigned.

Qualifications:

•Bachelor’s degree or equivalent industry experience in healthcare credentialing.

•Previous management experience preferred.

•Working manager with ability to complete any of the Department tasks and projects.

•Highly motivated and detailed orientated with the ability to complete tasks within an established timeframe and                  manage multiple projects and tasks.

•Knowledgeable AAAHC, CMS, HRSA, NCQA, and Missouri Department of Mental Health credentialing guidelines and   requirements.

•Strong knowledge in HIPAA.

•Strong and effective communication skills.

•Strong administrative/procedural decisions and judgments.

•Strong Microsoft Excel skills.

•Reliable and dependent leadership.

•Managed care knowledge preferred.

•NAMSS certification preferred.

•Other duties as assigned.