Resurgens Orthopaedics

Credentialing Manager

US-GA-Atlanta
Job ID
2018-2893

Overview

The Credentialing Manager independently manages all activities related to provider credentialing and recredentialing, according to the policies, practices, procedures, philosophy, compliance guidelines, objectives and mission of Resurgens, PC.

 

Responsibilities

ESSENTIAL DUTIES AND RESPONSIBILITIES

 

 

  • Credentialing new physicians and mid-levels with the insurance companies and follwing up weekly.  
  • Reappointment applications for the physicians and mid-levels.
  • For all Resurgens physicians, ensure continuity of Board Certifications, state licensure, Drug Enforcement Agency (DEA) certificate, Continuing Medical Education (CME) units, Purified Protein Derivative (PPD) tuberculosis test, National Provider ID (NPI) number, and data in Council for Affordable Quality Healthcare (CAQH) credentialing database, by requesting information from physicians and site managers and tracking and following up on responses.
  • For all Resurgens Physician Assistant (PA) and Nurse Practitioner (NP) staff, notify, track and follow up on required updates to ensure continuity of licensure, DEA, NPI, disclosure forms, job descriptions and PA Policy.
  • Work with Risk Management and Insurance Department as well as Human Resources Department as required to ensure issues related to above items are coordinated and well communicated.
  • Actively participate in provider recruitment efforts, including background checks and queries, scheduling of interviews, and planning and organizing applicable portion of the New Physician Orientation Program.
  • Maintain accuracy of Medicare and Medicaid provider numbers.
  • Provide timely submission of required materials for all physicians who require hospital privileges.

 

Qualifications

EDUCATION/EXPERIENCE

  •  Associates Degree preferred
  •  Minimum three years of related experience in credentialing or an equivalent combination of education and experience. 
  •  Knowledge of and experience in health care environment, with specific experience in a physician group and/or health plan preferred.  

LANGUAGE SKILLS

 Ability to:

  • read, analyze and interpret payer/health plan website information, Centers for Medicare and Medicaid Services (CMS) website information and bulletins, CAQH database elements, relevant portions of managed care contracts;
  • respond clearly and concisely to routine inquiries from internal and external contacts and to seek guidance from Director of Revenue Management in unusual or exceptional circumstances;    
  • develop and effectively present information to management team, Resurgens Board of Directors, and other audiences as required.

 

REASONING ABILITY

 

Ability to define problems, collect data, establish facts and draw valid conclusions utilizing professional judgment.

 

OTHER SKILLS AND ABILITIES

 

Strong interpersonal/communication skills required in order to work effectively with staff, physicians, other providers, physician candidates, and external contacts.  Willingness to work “hands on” and independently, and to adapt to a rapidly changing environment.

 

Ability to work constructively and harmoniously with staff, co-workers, physicians and other providers, as well as outside contacts. 

 

Demonstration of excellent process management skills and ability to determine and effectively manage priorities.

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