Job Summary: The Manager is responsible for the leadership and guidance of the payer credentialing process. The Manager is responsible for ensuring that all employed Memorial Providers are credentialed with the appropriate managed care agencies, governmental agencies and all participating insurance companies. The Manager will ensure operations of the assigned area in accordance with hospital policies, standards of practice of the profession, and State and Federal laws.
Manages and oversees the provider credentialing process
Oversees the preparation of provider enrollment applications, demographic updates and tracking metrics for all eligible provider types
Ensures enrollment activities meet federal, state and department guidelines when processing application submissions
Ensures each provider in credentialing databases and online systems is current; overseeing tracking of license and certification expirations to ensure timely renewals
Builds knowledge base for payer requirements and forms
Acts as liaison between practitioners and payers, identifies delays with payers, escalates and communicates delays or issues timely
Oversees the maintenance of files on each provider as required, items may include (CV, certifications, licenses, malpractice files, hospital privileges, etc.)
Manages team members to ensure that the enrollment process is handled quickly, professionally and efficiently
Maintains copies of current state licenses, DEA certifications, malpractice coverage and any other required credentialing documents for all providers, maintaining confidentiality of provider information
Works with revenue cycle management to ensure credentialing issues impacting the revenue cycle process are addressed timely
Creates and maintains provider CAQH
Leads project scope and objectives, involving all relevant stakeholders and ensuring feasibility
Delegates tasks and assigns responsibility for desired outcomes, based on expertise, work experience and time constraints
Partners with functional leaders regarding process improvements, communication and change management strategies related to new launches and deployments
Serves as a collaborator by communicating project goals, while driving an efficient decision-making process for project progression
Delivers progress of projects, while extracting and analyzing data and developing meaningful status reports and presentations
Manages services and activities related to the assigned area
Budgets within parameters
Monitors and adjusts staffing and workload as appropriate
Conducts interviews, hires, and employment actions; coaches team members and adheres to performance appraisal process
Oversees department programs and initiatives to assure compliance, optimization and continuous improvement
Education: Bachelor’s degree in Business, Accounting, Healthcare Administration, Finance or other fields of study. Additional experience may be accepted in lieu of degree.
Experience: Five (5) years of management experience in a Physician Business Office overseeing the provider credentialing process.
Education: Master’s degree in business or healthcare related field.
Internal Number: 9747
About Memorial Hospital at Gulfport
Memorial Hospital is dedicated to meeting the challenges of the future with a diverse workforce. We have jobs in clinical and non-clinical departments. No matter where you find your fit, your work is vital to our mission in healthcare and outreach.