The Credentialing Manager reports to the SVP of Operations and oversees delivery of superior credentialing verification services and privileging for all hospital entities, their medical staffs, and any contracted clients. Provides oversight for credentialing and provider enrollment and medical staff functions for all providers and assures timely enrollment of all facilities with payers. This is a hands-on position requiring the Credentialing Manager to oversee staff and processes ensuring that accurate data needed for credentialing has been obtained, maintained and current for all providers. The Credentialing Manager position requires professionalism, collaboration, and excellent decision-making skills.
NJ Eye LLC is a private-equity backed, independent, integrated eye care organization with its corporate headquarters in Union, New Jersey. The company has over 250 eye care professionals and business support roles across a growing network of over 17 eye care clinic locations, spanning New Jersey, with plans to affiliate with other eye care practices in New Jersey, New York, Connecticut, Pennsylvania, Delaware, Maryland, and nationwide.
Role and Responsibilities:
- Implements policies and procedures to ensure that applications are properly verified and accurately uploaded into an online credentialing database system
- Implements and oversees the data integrity and functionality of credentialing and enrollment databases
- Maintains the timelines on enrollment/credentialing schedules, communicates with providers and other departments to update as needed and maintain a strict level of confidentiality for all matters pertaining to provider credentials
- Obtains credentialing data needed for onboarding, contracting, and other related purposes. Credentialing data includes but is not limited to the medical degree, Drug Enforcement Administration (DEA) number, CDS, state licenses, Board certifications, CV, malpractice insurance etc.
- Works closely with providers and practice managers to obtain the necessary documentation pertaining to the onboarding and reappointment process. Obtains required provider signatures and follows up with the entities on documentation submitted
- Works with revenue cycle management to ensure compliance guidelines are established consistently throughout organization
- Communicate with billing and the office managers on updates as needed and explain payer information requirements
- Maintains provider information and demographics for all providers
- Obtains OIG, CMS, etc., reports on onboarding providers initially and annually per Corporate Compliance policy
- Creates & maintains provider CAQH
- Develops and implements standardized guidelines
- Maintains compliance with Federal and State regulations
Education: Bachelor's degree
Experience: 5-7 years of experience in healthcare compliance, credentialing and regulatory field in healthcare industry is highly desirable
- Understands provider enrollment
- Understanding of the credentialing and privileging processes for hospitals and ambulatory care settings a plus
- Computer Proficiency, Microsoft Office to include Word, Excel, Power Point
- Ability to work with multiple application specific databases
- Excellent interpersonal skills and customer service orientation
- Ability to work within and promote a team environment
- Attention to detail
- Ability to work with multiple projects and deadlines and to support medical staff leaders and functions.
- Strong analytical skills
- Ability to coach and mentor staff
- Excellent written and verbal communication skills and organizational ability
- Possesses strong management skills
- Knowledge of HIPAA, HITECH and other rules and regulations in the healthcare industry
- Ability to thrive in a fast-paced, dynamic organization
NJ Eye LLC is an Equal Opportunity / Affirmative Action employer. Candidates are selected solely on the basis of legally permissible job-related criteria without regard to race, color, religion, sex, national origin, disability, marital status, or sexual orientation, in accordance with federal and state law.