Unit Manager Credentialing - Committee

Unit Manager Credentialing – Committee

Bachelor Degree OR 4 years business experience.
Plus 4 years’ experience in credentialing OR 4 years supervisory experience in a production or inventory driven environment
3 years’ management or leadership experience.
Experience in a production or inventory driven environment with a focus on operations, state and federal regulations, industry standards and/or quality concepts.
Experience implementing and managing projects and programs.
Experience implementing policies, procedures, processes, and workflows.
Analytical skills and experience identifying and resolving workflow and system problems.
Written, verbal and interpersonal communication skills to present clear, concise and accurate information; facilitate meetings and manage diverse groups, and build relationships with employees and external customers.

Managing the enterprise credentialing committee activities in compliance with accreditation standards and state regulations.
Managing the ongoing monitoring process and administrative denial processes.
Managing the onboarding/recredentialing providers presented to the committee.
Sending decisions to the providers according to the required turnaround time.
Managing network terminations accurately.
Collaborating with interdepartmental leaders for the development, implementation, and maintenance of policies, procedures, workflow processes, and developing departmental goals related to Credentialing committee activities.
Managing the team of credentialing coordinators and Sr credentialing representatives and ensuring the teams meet or exceed goals, initiatives, and operational effectiveness.

Knowledge of Symplr Payer, PPW.
Knowledge of NCQA, URAC, CMS, and state Departments of Insurance regulatory requirements.
Experience in managed care credentialing, Medical Practice or Medical Staff office.
Experience developing innovative solutions to ensure objectives are accomplished.
Knowledge of Vistar/Vistar.