Credentialing Manager - Northbrook, United States - USA Clinics Group

USA Clinics Group
USA Clinics Group
Verified Company
Northbrook, United States

1 week ago

Mark Lane

Posted by:

Mark Lane

beBee recruiter
Description
At
USA Clinics Group, we use our expertise to provide the best possible service for our patients. Our team members are passionate about making a difference in the lives of the people we treat and are constantly striving to improve and better ourselves so that we can better support our patients and are currently searching for a
Credentialing Manager to join our team


As the
Credentialing Manager you would be responsible for overseeing the credentialing and re-credentialing process for all providers in 170+ clinics across 30 states.


This position works on-site at our Corporate Headquarters located in Northbrook, Illinois

Responsibilities:


  • Processes physician accreditation, managed care, governmental and commercial insurance enrollment and recredentialing
  • Responsible for daily provider data management and review of credentialing files for accuracy and completeness, utilizing internal and external sources
  • Responsible for analyzing clinic utilizations and develop physician location scheduling recommendations
  • Analyze local payor IPA markets for partnerships or payer contracting opportunities
  • Performs primary source verification via various state and national sources
  • Maintains individual provider credential files with all the appropriate documentation consistent with AAAHC and NCQA standards
  • Oversees, updates and maintains provider credential database including CAQH, PECOS, NPPES Registry, Sharepoint any other applicable regulatory agencies
  • Develops and prepares analytical reports monthly/quarterly of the summary of credentialing activity
  • Responds timely to provider inquiries by letter, phone or internal communication
  • Work closely and maintain relationships with provider relations at each payer, and communicates any challenges and/or concerns with manager timely
  • Maintain Credentialing Applications for accuracy and completeness
  • Additional duties as assigned
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