Credentialing Manager

4 weeks ago

Springfield, United States CoxHealth Full time

Summary

About Us

CoxHealth is a leading healthcare system serving 25 counties across southwest Missouri and northern Arkansas. The organization includes six hospitals, 5 ERs, and over 80 clinics. CoxHealth has earned the following honors for workplace excellence:

  • Named one of Modern Healthcare’s Best Places to work five times.
  • Named one of America’s Greatest Workplaces by Newsweek.
  • Recognized as a Greatest Workplace for Women in both 2023 and 2024.
  • Listed as one of the Greatest Workplaces for Diversity in 2024.
  • Acknowledged by Forbes as one of the Best Employers for New Grads.
  • Ranked among the Best Employers by State for Missouri.

Benefits

  • Medical, Vision, Dental, Retirement Plan with employer match, and many more
  • For a comprehensive list of benefits, please click here: Benefits | CoxHealth
  • Job Summary
    • The Managed Care Credentialing Manager is responsible to develop, manage, and monitor the CoxHealth Network (CHN) department managed care credentialing processes and procedures. The Managed Care Credentialing Manager’s core responsibilities include oversight of all network practitioner, facility and ancillary provider credentialing, re-credentialing, peer review processes, meeting the requirements of payor contracts, payer credentialing policies and NCQA/URAC accreditation standards.  This includes management of all sub-delegate contracts and credentialing efforts, including annual audits of sub-delegate organizations.  This individual will lead Peer Review Committee and lead and/or participate in various CoxHealth Network and system meetings.  This position is responsible for the creation and maintenance of all CHN managed care credentialing policies, procedures, standards and manuals.  The manager is responsible to manage, develop and have oversight of all CHN credentialing staff and will be the primary credentialing contact with payers. Coordinates and supervises credentialing audits and on-site reviews with payers.
  • Job Requirements
    • Education
        • Required: A Bachelor’s Degree in Business Administration, Finance, Healthcare Management, Human Resources or a related field OR at least 4 years of equivalent experience
        • Preferred: Master’s Degree in Healthcare
    • Experience
        • Required: 5 years of managed care, insurance, clinic management or other healthcare experience
        • Preferred: 2 years of management experience or equivalent; working knowledge of managed care or med staff credentialing and organizational structures;
    • Skills
      • Strong interpersonal and communication skills, including ability to motivate people
      • Clear, concise writing and presentation skills
      • Ability to maintain fast pace and manage a diverse and demanding workload
      • Decisive and capable of exercising good judgment under pressure
      • Ability to work collaboratively with physicians, providers, managers, and staff
      • Proficient computer skills and experience with Microsoft Office applications
    • Licensure/Certification/Registration
      • Preferred: Certified Professional in Healthcare Quality or Certified Credentialing Professional

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