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    Manager - Provider Credentialing and Enrollment - Annapolis, United States - Luminis Health

    Luminis Health
    Luminis Health Annapolis, United States

    4 days ago

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    Description
    Position Objective:

    The Manager, Credentialing and Provider Enrollment provides Strategic Leadership to Luminis Health. Oversees the departmental operations, assuring the delivery of superior credentialing verification services for all hospital entities, their medical staff, and any contracted clients. Provides oversight for credentialing and provider enrollment and collaborative medical staff functions for all LHCE employed providers and assures timely enrollment of all LHCE facilities and medical groups with payers.

    Essential Job Duties:

    1. Oversees the supervision of personnel, which includes work allocation, training, promotion, enforcement of internal procedures and controls, and problem resolution; Evaluates performance and makes recommendations for personnel actions; motivates employees to achieve peak productivity and performance.
    2. Manages the provider enrollment/delegated credentialing processes, standard workflows, timelines, and master provider rooster.
    3. Manages the credentialing database and associated modules, ensuring accuracy of data, and reporting to downstream systems. Monitors critical data for extensive analysis and report generation.
    4. Manages the CVO credentialing processes for all Luminis Health System clinical providers, in accordance with the TJC, CMS, NCQA, DNV, state and federal laws and system policies.
    5. Prepares for and coordinates credentialing audits in compliance with managed care delegated contract requirements and NCQA audit compliance.
    6. Ensure all applications and data contained are tracked to provide real time updates with leadership.
    7. Monitors and reports turnaround times for processing of credentials applications, with focus on delivery of a high-quality product with greatest efficiency, in the least amount of time.
    8. Creates and monitors standard work for provider enrollment practices.
    9. Creates and monitors standard work for primary source practices.
    10. Represents the CVO to internal and external customers. Problem solves and manages issues as they arise.

    Educational/Experience Requirements:
    • Bachelor's degree in related area required.
    • Minimum 5 years of experience in healthcare operations with an emphasis on credentialing and provider oversight
    • Minimum 2 years of management experience
    License/Certifications:
    • CPCS (Certified Provider Credentialing Specialists) Preferred
    Working Conditions, Equipment, Physical Demands:

    There is a reasonable expectation that employees in this position will NOT be exposed to blood-borne pathogens.

    Physical Demands -

    Light Work: Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects. If the use of arm and/or leg controls requires exertion of forces greater than that for

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