Manager, Credentialing - Oakland, United States - Altais

Description

Job Description

At Altais, we're looking for bold and curious clinicians and innovators who share our passion for enabling better health care experiences and revolutionizing the healthcare system for physicians, advanced care providers, patients, and the clinical community. At Altais, we're building breakthrough clinical support tools, technology, and services to let doctors do what they do best: care for people. We invite you to join our growing passionate team as we change the game for the future of healthcare and enable the experience that people need and deserve. Altais family of companies include Brown & Toland Physicians, Family Care Specialists and Altais Medical Groups.

About Your Team

Are you looking to work with a high performing, fast growing and dynamic Transformation team? We are 4,000+ physicians, working in over 40 cities throughout California, caring for more than 500,000 patients. If you are passionate about reshaping healthcare and want to work for a mission driven organization where new ideas and innovation are valued, then we would like to meet you.

About Your Work

As the Credentialing Manager, you will be responsible for the direct supervision of day-to-day operations of the credentialing and provider enrollment functions to support, develop, manage and monitor processes and procedures for the credentialing, re-credentialing, expirables data management and delegated functions for all our Health Plan Partners for all lines of business. This role manages the credentialing program for Altais affiliated entities, including employed clinicians, vendors providing clinical services on the MSOs behalf, as well as MSO services for any other medical group or IPA purchasing from Altais Health Solution including application management and primary source verification completion. This role is also responsible for the administrative aspects for all credentialing functions needed to meet medical group, health plan and accrediting body requirements including but not limited to National Committee for Quality Assurance (NCQA) and CMS. This role, in combination with the Credentialing team is to maintain procedures and processes in line with all regulation and compliance requirements. Additionally, this role will oversee the interdependencies between departments, consistently maintaining knowledge and understanding of the impact to providers and how that may affect overall business operations and financial outcomes.

You will focus on

• Providing leadership / coaching to the credentialing team staff, ensuring function initiatives and deliverables are complete and accurate in a timely manner
• Responsible for processing credentialing applications accurately and promptly in accordance with Credentialing policies and procedures and in full compliance with all regulations with a continued focus on delivery of a high-quality product with the greatest level of efficiency
• Manages audit preparation of materials and files necessary to comply with external audits by payors and/or governmental agencies
• Manages relationships with health plan delegation oversight committee members.
• Manages process for initial and re-credentialing review by Clinical Advisory Group for exception physicians
• Manages claims and appeals and peer review physician documentation for Clinical Advisory Group
• Oversee provider health plan enrollment for employed physicians
• Conduct audits of the credentialing database, confirming accurate input of provider data, and verifying accuracy of modifications made to the database and downstream impacts to other reporting tools and functions
• Owns end to end delegated credentialing process
• Develops functional, market level, and/or site strategy, plans, production and/or organizational priorities for Altais Health affiliated groups as well as clients purchasing MSO services.
• Identifies and resolves technical, operational and organization problems outside own team
• Develop monthly management reports illustrating current status, back-log and trends
• Serves as SME and provide strategic direction for business requirements for sPayer
• Other duties as assigned

The Skills, Experience & Education You Bring

• Independently resolve issues and to develop solutions for existing problems to be escalated to internal leadership where appropriate
• Worked with Management Services Organization (MSO) or large at-risk provider practice
• Understand the use credentialing software and automation to improve workflow
• Oversees the supervision of personnel which may include work allocation, training, enforcement of internal controls; evaluates performance and motivates employees to achieve peak productivity and performance
• Ability to work with internal stakeholders to develop technical solutions to improve accuracy and efficiency of processes and reporting
• Excellent communication skills, both written and verbal, as well as strong organizational and administrative abilities
• Advanced Excel knowledge is required
• Required:
• Bachelor's degree or equivalent to 4 year university degree, preferably in healthcare related field of study
• 5+ years professional experience working in credentialing, preferably in a managed care setting
• sPayer (eVIPs, Cactus) credentialing experience
• Must be eligible to take National Association Medical Staff Services (NAMSS), Certified Provider Credentialing Specialist exam within 18 months of employment
• Preferred:
• Master's degree or other advance level education
• 7+ years professional experience working in credentialing, with 2+ years of employee / team management experience
• NAMSS Credentialing certification

You Share our Mission & Values

• You are passionate about improving the healthcare experience and want to be part of the Altais mission.
• You are bold and curious- willing to take risks, try new things and be creative.
• You take pride in your work and are accountable for the quality of everything you do, holding yourself and others to a high standard.
• You are compassionate and are known as someone who demonstrates emotional intelligence, considers others when making decisions and always tries to do the right thing.
• You co-create, knowing that we can be better as a team than individuals. You work well with others, collaborating and valuing diversity of thought and perspective.
• You build trust with your colleagues and customers by demonstrating that you are someone who values honesty and transparency.

Altais values the contribution each Team Member brings to our organization. Final determination of a successful candidate's starting pay will vary based on several factors, including, but not limited to education and experience within the job or the industry. The pay scale listed for this position is generally for candidates that meet the specified qualifications and requirements listed on this job description. Additional pay may be determined for those candidates that exceed these specified qualifications and requirements. We provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs.

The anticipated pay range for this role is listed in our salary posting for transparency but may vary based on factors including the candidate's qualifications, skills, experience, and geographic location. This base pay range is specific to California and can vary based on Bay Area, Metro LA, and Greater California regions which may not be applicable to other locations.

Altais and its subsidiaries and affiliates are committed to protecting the privacy and security of the personal information you provide to us. Please refer to our 'CPRA Privacy Notice for California Employees and Applicants' to learn how we collect and process your personal information when you apply for a role with us.

Physical Requirements: Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork – Activity level: Sedentary, frequency most of workday.

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.