Credentialing Manager Overview

The Credentialing Manager is responsible for overseeing the facility credentialing process and payor enrollment for healthcare providers working in the hospital, ensuring compliance with regulatory standards, organizational By-Laws and policies, procedures, and protocols. This role involves managing facility credentialing and payor enrollment processes, including without limitations, maintaining accurate and up-to-date provider credentialing and enrollment records, and facilitating communication between internal departments, vendors, and external agencies.

Credentialing Manager Key Responsibilities:

Credentialing Process Management:

• Oversee the credentialing process for healthcare providers, including physicians, CRNAs, and allied health professionals.
• Develop, implement, maintain and enforce credentialing policies and procedures in compliance with facility By-Laws, department policies, accreditation standards and regulatory requirements.
• Coordinate with the individual clinicians, MLBH medical staff office, and other departments to ensure timely completion of credentialing and recredentialing applications.
• Coordinate with the individual clinicians, billing company, and other Somnia departments to ensure timely completion of enrollment and reenrollment applications.

Provider Credentialing

• Manage and coordinate the initial credentialing, privileging, and enrollment process for new providers, including verification of credentials, licensure, DEA certificates, education, training, and professional references.
• Ensure all credential files are accurately maintained and updated according to established protocols.
• Monitor expiration dates for credentials and licensures and initiate the recredentialing process as required.

Quality Assurance and Compliance:

• Conduct quarterly audits of credentialing files to ensure accuracy, completeness, and compliance with regulatory standards and organizational policies.
• Implement quality assurance measures to identify areas for improvement in the credentialing process and address any deficiencies.

Credentialing Manager Qualifications

• Excellent communication, organizational, and follow up skills.
• Team player and collaborator
• Anesthesia experience a plus/ preferred
• Healthcare experience necessary