Manager, Provider Intake & Credentialing

What We Provide

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life Disability
• Employer-matched retirement saving funds
• Personal and financial wellness programs
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities

What You Will Do

• Manages provider intake process which includes contracting handoff, credentialing and configuration of providers for VNS Health Plans. Evaluates current processes and workflows; makes recommendations for improvement as appropriate.
• Ensures that due diligence is performed on all entities to which credentialing may be delegated. Oversees credentialing reviews/audits in accordance with established policies and procedures. Monitors the delegated entities performance and reports findings to the Credentialing Subcommittee.
• Manages compensation grid configuration in Salesforce and Facets Environment.
• Coordinates and participates in training of department staff, including development of materials, demonstration of new systems and processes.
• Oversees investigations and reconciliation of credentialing/re-credentialing workflow issues. Leads the research and resolution of escalated issues related to applications and verification.
• Collaborates with Quality Improvement/Management Departments in quality assurance monitoring and evaluation of network providers. Evaluates and analyzes findings from audits and works with appropriate staff to develop/implement corrective plan of action, as needed.
• Identifies and reports trends to management; develops reports that recognize and identify potential/suspected issues. Manages reports for all metrics to ensure department goals are met and/or exceeded. Provides recommendation to address trends and resolve issues to ensure provider satisfaction.
• Manages, monitors and audits initial and re-credentialing process for contracted providers in collaboration with department staff. Conducts audits for in-network providers with delegated credentialing responsibilities and ensures required documentation is up-to-date. Follows-up with providers to investigate/resolve re-credentialing issues and apprises Credentialing Committee and senior leadership, as necessary.
• Performs all duties inherent in managerial role. Recommends hiring, salary actions, performance appraisals, promotions, termination and performs orientation/training to facilitate the professional growth and development of assigned staff.
• Participates in special projects and performs other duties as assigned.

Education:
Bachelor's Degree in Health Administration, Business Administration, related discipline, or equivalent work experience required. Master's Degree preferred

Work Experience:
Minimum of five years experience in health care delivery systems required. Minimum of two years managerial experience preferred. Experience working in healthcare administration and/or operational programs required. Experience working with healthcare providers as customers or clients required. Thorough understanding of network contracting and credentialing required. Intermediate level Microsoft Office, with high proficiency in Excel required. Salesforce experience preferred