Credentialing Manager
Job Title:
Credentialing Manager
Type:
Full Time
Location:
Remote
About Us:
KeyCare offers health systems access to a network of virtual care providers working on KeyCare's Epic-based EMR and telehealth platform. This allows KeyCare to improve access for patients across the United States, while keeping their care coordinated with their health system partners. Health systems can start with nationwide virtual on-demand urgent care coverage (24x7, 50-state coverage), and then may add other virtual health services based on their needs. To learn more about KeyCare, visit www.keycare.org
Position Overview:
As the Credentialing Manager, you will be responsible on a day-to-day basis for all provider credentialing related tasks, using the Verifiable credentialing platform, ensuring all providers are properly credentialed within our medical group in accordance with NCQA accredited guidelines. The Credentialing Manager will ensure that all credentialing tasks and processes, including but not limited to provider onboarding, credentialing, licensing, and payer enrollment, are properly prioritized and completed as swiftly and effectively as possible to support company operational and growth goals and strategies. This role will assist with customer engagement activities as it relates to provider availability and utilization from time to time.
In this role, you will:
- Collaborate with the KeyCare Inc. management team to plan and execute company strategies.
- Forecast clinical staffing needs and ensure that provider staffing pipeline provides sufficient clinical resources to meet business needs and future growth.
- Manage day-to-day efforts and personnel to achieve clinical staffing objectives
- Stay abreast of regulatory requirements and company compliance policies, ensuring timely staff education
- Other responsibilities as assigned
Key Responsibilities:
- Does all that is necessary to ensure that sufficient clinical provider staff resources are credentialed in advance and ready to meet upcoming clinical service needs including direct provider credentialing work.
- Supervises all credentialing team personnel and activities related to provider onboarding, credentialing, licensing, and payer enrollment, provider file maintenance, communications, and delegated credentialing activity
- Ensures the department continually follows NCQA guidelines and continually provides suggestions and feedback as to how to streamline processes and procedures.
- Participate in NCQA survey readiness activities
- Manages customer requirements as they may relate to credentialing and/or delegated credentialing activity
- Manages all personnel functions within the department and conducts necessary employee evaluations and reviews working closely with the management team to ensure anything affecting the performance of the operation is resolved effectively
- Ensures the Credentialing Department maintains appropriate documentation including program descriptions, playbooks, policies, and other reference materials to maintain consistent operations and in compliance with federal, state, and safety regulations
- Creates a positive and productive work environment to attract and retain talent
Qualifications:
- Knowledge and understanding of standard credentialing guidelines and procedures related to credentialing and activity related to the maintenance of all provider credentialing and correspondence files
- Knowledge of general aspects of clinical care and clinic operations
- Experience in working with physicians, physician groups and hospital systems
- Knowledge and understanding of all aspects of provider relations
- Must possess above average oral and written communication skills and the ability to independently prioritize duties and assignments
- Must be capable of working under pressure situations and must be capable of adapting to various workloads and assignments
- Enthusiastic and creative manager with the ability to inspire others
- Demonstrated ability to work independently and with a sense of urgency in a dynamic environment
- Minimum five (5) years’ progressive provider credentialing management experience
- 3 years managerial experience, including supervision of support staff and management oversight of individuals who are self-directed or organized
- Experience with “Verifiable” credentialing software is a major plus
Education, Experience, and Licensing Requirements
- Bachelor’s degree preferred
- Preferred certifications:
- Certified Provider Credentialing Specialist (CPCS)
- The National Committee for Quality Assurance (NCQA)
- Utilization Review Accreditation Commission (URAC)
- The Accreditation Association for Ambulatory Healthcare (AAAHC)
Travel Requirements
Travel up to 5%
Benefits:
Eligible for company benefits:
- Medical
- Vision
- Dental
- Life Insurance
- 401K
- Disability
- Unlimited PTO
How to Apply:
Please reach out to the email listed below.
Include the position title you are applying to in the subject line.
Include a brief intro in the body, and attach your cover letter and resume to the email. Our team will reach out with next steps.
How to Apply:
Please reach out via the external link button below.
You will be asked to attach a resume, and provide required personal info & provider details.
KeyCare is an Equal Opportunity/Affirmative Action Employer
We encourage all qualified applicants to apply. KeyCare is committed to its evolution towards a diverse and inclusive workplace. All qualified applicants will receive consideration for employment without regard to race, ethnicity, religion, gender or gender identity, sexual orientation, age, marital status, disability, sex, country of origin, or veteran status.
Reach Out to Our Team Today!
Our team is looking forward to hearing from you, and happy to answer any questions
