Professional - Non-Clinical
Senior Manager of Credentialing – Managed Care – Maitland
Florida Hospital’s Managed Care department seeks to hire a Senior Manager of Credentialing who will embrace our mission to extend the healing ministry of Christ.
Work hours / Shifts:
Full Time – Monday-Friday – 8:00am-5:00pm
The primary role of the Senior Manager of Credentialing is to direct all physician provider credentialing, provider demographic data, and delegated credentialing functions while managing the daily operations of the credentialing team including selection, training, and supervision of staff. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.
Knowledge, Skills, Education and Experience Required:
Management and leadership skills
Extensive knowledge of provider credentialing/enrollment (Managed Care and Government)
Excellent quantitative, verbal, written and interpersonal skills
Developed skills to analyze, present, and evaluate Managed Care contract revenue issues
Financial analysis and spreadsheet experience
Extensive provider reimbursement knowledge
Knowledge of NCQA credentialing standards and delegated credentialing
Solid experience using Windows and Microsoft Outlook, PowerPoint, Excel, Word
Exercise independent judgment in interpreting National Commission for Quality Assurance, CMS, state laws and regulations as they pertain to the credentials of Provider and Facility applicants.
Problem solving skills and ability to explore all options and use available resources to find new and effective solutions.
Ability to communicate appropriately and effectively with providers; including sensitive and confidential information.
Must be able to prioritize and meet deadlines on an ongoing basis to ensure timely completion according to process requirements.
Excellent people manager who exhibits sound judgment and who can hold themselves up as a role model and mentor.
Language Skills: Ability to read, analyze, and interpret documents, reports, technical procedures, governmental regulations, and correspondence; ability to write routine reports and correspondence; and ability to present information in one-on-one, small group, and large group situations to management and staff. Ability to apply proper grammar, spelling, punctuation, and format to typed material. Must have excellent oral and written communication skills.
Mathematical Skills: Ability to work with mathematical concepts such as probability and statistical inference; ability to compute discount, interest, profit, loss, ratios and percents; and ability to draw and interpret graphs.
Reasoning Ability: Ability to solve a wide range of practical problems and deal with a variety of concrete and complex variables; ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form; and ability to deal with multiple variables.
Other: Ability to operate related computer applications (i.e. word processing and spreadsheet applications), and business equipment including, personal computer, copy machine, fax machine, and telephone. Well organized with the ability to maintain attention to detail. Good conceptual, organizational, and problem solving skills. Ability to work independently and as a team member. Ability to apply legal standards to employment situations.
Microsoft Access, Morrisey/Apogee, SyMed, NextGen, Misys
Bachelor’s degree in relevant field, such as Health Services Administration, and/or five years equivalent experience
Five to seven years experience in a large practice setting, PHO, health plan and/or medical staff service setting with responsibilities overseeing and managing credentialing including experience in delegated credentialing.
Three years of experience in a managerial or supervisory capacity
More than five (5) years experience in credentialing within a large practice setting, PHO, health plan and/or medical staff service setting with responsibilities overseeing and managing credentialing including experience in delegated credentialing.
Master’s degree in a relevant field.
Five or more years in a leadership/management position over credentialing in one of the above settings highly preferred.
Licensure, Certification, or Registration Required:
Certified Provider Credentialing Specialist (CPCS) certification and/or
Certified Professional Medical Staff Management (CPMSM) certification or
Must obtain CPCS or CPMSM within one year of hire
CPCS or CPMSM certification at time of hire
Demonstrates through behavior Florida Hospital’s core values of Integrity, Compassion, Balance, Excellence, Stewardship, and Teamwork.
Provide oversight of credentialing for “delegated” and “non-delegated” physician groups.
Achieve and maintain delegated credentialing status with targeted payers.
Collaborate and coordinate with Florida Hospital Medical Staff and respective physician organizations (e.g. FHMG) to maintain efficient and effective flow of information and processes.
Maintain effective credentialing processes and standards that are physician-centric and focus on delivering exceptional customer service to the physicians of FHMG and other practice entities.
Provide oversight and guidance to the provider data and credentialing team to assure all timelines, accuracy of data and work processes are met. Lead the credentialing team and provide management in a way that promotes a positive, motivated working environment embodying the core values of Florida Hospital.
Coordinate and collaborate with FHMG leadership in order ensure timely credentialing is completed.
Timely and accurate reporting to the respective CMO and chairperson of the Credentialing, Performance and Quality (CPQ) Committee of the FHMG Board. Prepare, plan, and lead CPQ meetings for the credentialing content of the meeting. Coordinate other agenda items as needed.
Assure all federal and state reporting requirements are met. Adherence to and compliance with NCQA credentialing standards in order to ensure all NCQA certification are satisfied for delegated credentialing with payers.
Other duties as assigned.
If you want to be a part of a team that is dedicated to delivering the highest quality in patient care, we invite you to explore the Senior Manager of Credentialing job opportunity with Florida Hospital’s Managed Care department and apply online today!
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