Position Summary

The Credentialing Manager is responsible for overseeing all aspects of the Credentialing and Payor enrollment of urgent care providers following company, regulatory, and payor standards.

Duties and Responsibilities

• Overseeing Credentialing process of new hire providers through the credentialing verification organization
• Ensures all current provider maintain proper credentials
• Responsible for reviewing completed files and obtaining final approval from the Medical Director prior to clearing for hire
• Ensures all necessary applications has been filed with contracted health plans for all centers
• Reviews website for any past legal history or sanctions (NPDB) and responsible for maintaining monthly checks for discrepancies
• Manages vendor relationships to ensure a productive working relationship
• Works with multiples departments to ensure all aspects of the process are completed to company and regulatory standards
• Responsible for applying for and maintaining all center licensure, including but not limited to: AHCA, CLIA, and HCC (OTHERS?)
• Oversees special projects related to process and quality improvement
• Advises other departments and leadership of any unforeseen issue that may cause claims problems

Experience, Skills and Education

• Strong communication and interpersonal skills with the ability to confidently engage providers, payers, and internal stakeholders
• Ability to proactively follow up and drive timely resolution of credentialing issues
• Demonstrates professional confidence and accountability when enforcing policies and compliance standards
• Bachelor’s Degree; Certified Provider Credentialing Specialist preferred

• 5 years’ healthcare experience in credentialing
• Knowledge of revenue cycle, billing and claims is preferred
• Strong knowledge of Microsoft products
• Strong verbal and written communication skills (spelling, grammar, etc.)
• Ability to pass a Level II background screening and clearance through AHCA (Agency for Healthcare Administration) - https://info.flclearinghouse.com/