Jobs

Provider Relations & Credentialing Manager

About the Role:

We are looking for a self-motivated and enthusiastic Provider Relations and Credentialing Manager. This individual is responsible for the development and implementation of the strategic plan for network support and service. This position provides leadership in the development of strategic plan, budgets, forecast, monitor, facilitate internal, conduct internal audits, compliance and execution of these goals.

 

Essential Duties and Responsibilities:

•                Establish and maintain network providers relationships and partnerships.
•                Manages and or leads a team in the support of an overall provider network, develop, and execute a plan(s) for service objectives.
•                Interprets and keep up with requirements and disseminates information to all involved parties to assure necessary compliance, compatibility and continuous quality improvement of provider relations and credentialing processes.
•                Develop and maintain a Provider Manual, Provider Relations Policies, Credentialing Program, Credentialing Policies, Audits and provider collateral training materials in compliance with regulatory and NCQA requirements.
•                Participate in audits, internal and external. Maintain departments’ policies and procedures to meet regulatory standards.
•                Prepare documentation and participate in special projects and assignments.
•                Manage the daily functions of the Credentialing staff processing credentialing and re-credentialing applications for providers and organizations according to National Committee for Quality Assurance (NCQA) standards.
•                Ensure CR and Re-CR timelines and due dates are met.
•                Manages credentialing function. Coach, train and direct work of credentialing staff.
•                Attend and facilitate Credentialing Committee. Oversee the quality of materials presented at Credentialing meetings, ensuring agendas, supporting documents, and minutes are prepared timely and accurately.
•                Develop, facilitate and train providers and staff regarding the company’s policies to include coordination of necessary compliance training materials
•                Develop and train providers and staff regarding the company’s operations to include coordination of necessary compliance training and communication with the Compliance Officer
•                Manage the credentialing process and oversee the delegated credentialing process performed by contracted entities. Ensure that delegated entities submit required documents on schedule and follow-up as required.
•                Oversee timely audits of delegated credentialing activities.
•                Train and monitor staff in the delivery of excellent customer service.
•                Monitor staff productivity, accuracy, and service delivery using performance standards.
•                Oversee and ensure compliance of the credentialing activities of the company’s network of providers and other downstream and related entities.
•                Ensure credentialing policies are followed and standards are adhered to meet regulatory standards.
•                Manage, identify, research, resolve, and report any issues involving daily workflow and quality of work
•                Meet with physician group representatives on regular basis to identify network, contractual and partnership opportunities
•                Assist providers with problem resolution, as necessary
•                Ensure accurate and updated provider information on website
•                Develops ongoing relationship with providers& outside agencies relevant to network health and provider business support
•                Manages problem resolution and quality monitoring including provider complaint reports
•                Interviewing, hiring, training, exiting employees; planning assigning, and directing work; appraising performance; addressing complaints and resolving problems
•                Maintain compliance with Federal and State regulations and regulatory standards.
•                Conduct probationary and annual performance evaluations.
•                Other duties as assigned

 

Core Qualifications:

•                Bachelor’s degree in Health Care, Marketing, Business or related field required.
•                3 years’ experience working in a health care environment.
•                Minimum 1 year management experience.
•                At least 2 years of Credentialing experience preferred.
•                Strong attention to detail and critical thinking, problem solving and analytical skills.
•                Demonstrated ability to work collaboratively, multi-task and meet deadlines in a complex, rapidly evolving environment with staff across the organization/departments.
•                Proficiency in MS Office suite.
•                Strong interpersonal, communication, organizational and time/project management skills are essential.
•                Excellent written and verbal communication skills.

For more information about Trivium, visit www.trivium.com Interested applicants may forward a résumé, cover letter and references to the attention of Ramya at ramya.ramesh@triviumcs.com.

We are an Equal Opportunity/Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources. EEO is the Law: poster_screen_reader_optimized.pdf

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