Manager - Credentialing & Contracting

1 month ago

Toledo, United States Harbor, Inc. Full time
Job DescriptionJob Description

Harbor is looking for a Manager of Credentialing & Contracting who is responsible for the day-to-day operations of credentialing new and established health care provider, agency and all practice locations with multiple payer sources in a timely and complete manner. Provides leadership, direction and oversight to the credentialing and insurance follow up teams.

Position is full-time

Education/Experience/Other Requirements:

  • Bachelor’s degree in business administration, healthcare, behavioral science or related field required. In lieu of Bachelor's degree, Associates degree with minimum of 2 years billing or credentialing experience required.
  • Behavioral Health and Ohio Medicaid experience preferred.
  • Prior experience credentialing employees and agency with insurance carriers preferred.
  • Minimum 2 years’ experience of insurance follow up preferred.
  • Must have excellent communication skills, both verbal and written.
  • Must be able to demonstrate an ability to meet deadlines in a multi-functional task environment.
  • Requires excellent organizational skills and advanced computer skills with experience working in electronic health records and practice management systems.
  • Must at all times maintain efficiency and timeliness in all daily activities.
  • Must be able to establish daily work priorities and work efficiently to contribute to the successful overall maintenance of the credentialing process as well as the insurance follow up processes.
  • Provides optimal customer service to meet the organizations expectations.
  • Must have a valid driver’s license, acceptable driving record, and show proof of personal auto insurance policy to be deemed insurable with Harbor’s vehicle insurance carrier.

Essential Job Competencies/Primary Duties:

  1. Provides personnel management functions for assigned staff including hiring, training, supervision, annual evaluation, coaching for success, and disciplinary actions.
  2. Conducts initial and ongoing staff training in schedule prioritization, workflows and job responsibilities. Develops and maintains detailed written standard operating procedures for major workflows in the department.
  3. Investigates requirements for new managed care contracts and continually monitor/manage existing contracts for needed updates/changes.
  4. Oversees the process of the preparation and submission of appropriate paperwork and documentation for new credentialing and the recertification or additional information requests of existing credentialed staff.
  5. Assists in obtaining new and existing clinical staff information for completing needed credentialing.
  6. Maintains credentialing information in National Database and SmartCare.
  7. Must be knowledgeable and current on the process and legal/regulatory requirements.
  8. Assists in maintaining payer portals, information, and billing systems.
  9. Provides support to executive management in relation to credentialing and contracting.
  10. Establish and maintain effective working relationships with payers, third party provider enrollment entities, payer contacts as well as internal staff.

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