Manager, Provider Credentialing

2 months ago

Fort Myers, United States DNA Comprehensive Therapy Services Full time
Job DescriptionJob DescriptionDescription:

Come grow with us Elite DNA Behavioral Health is one of the largest providers of behavioral and mental health services in Florida – and we are expanding quickly We believe in providing high-quality, accessible care to our patients and a supportive environment that allows our team to grow professionally.


Our goal is to hire you – the best talent – to support our mission and allow you to grow with us.


We thrive on a mutual goal of providing excellent care to our patients through our comprehensive care services and collaborative culture. Elite DNA is the pioneer of the care coordination approach to mental health, where all patients are matched with their ideal services and providers prior to receiving direct care. Our team is at the forefront of providing leading-edge therapy services – from psychotherapy to psychiatry – to specialized programs such as psychosocial rehabilitation, EMDR, and group therapy.


Everything we do here at Elite DNA is guided by integrity and compassion for our patients and employees.


When you join the Elite DNA team, you will feel proud to be a part of the group that helps children, adults, and families in our communities live better lives.


Job Summary:

Elite DNA Behavioral Health is seeking to hire a full-time Manager of Provider Credentialing for the Fort Myers office.


DESCRIPTION:

The Manager of provider credentialing is tasked with overseeing, improving, and ensuring a smooth credentialing process through the development of staff, maintenance of work integrity, and enhancement of team performance. This role mandates meeting or surpassing established metrics, and objective goals for the department. Adaptability to a challenging environment is essential. The ideal candidate should possess experience in Behavioral Health credentialing and an advanced understanding of various insurance carriers, including Medicare, Medicaid, Blue Cross/Blue Shield. Candidates should demonstrate the ability to identify and effectively resolve issues, communicate all matters to leadership, work independently, devise resolution plans for issues, and promptly report any delays or concerns with the provider credentialing process.

RESPONSIBILITIES:

· Coordinates the management of Elite DNA’s credentialing database and associated modules, ensuring accuracy of data and reporting to downstream systems. Monitors critical data for extensive analysis and report generation.

· Coordinates the management of the electronic credentialing applications, to ensure distribution, receipt, processing, and timely delivery to payers.

· Coordinates the management of the expirable process to ensure all clinical provider licenses and certificates remain current, ensuring appropriate notification prior to expiration.

· Monitors and reports turnaround times for processing of credentialing applications, with continued focus on delivery of a high-quality product, with the greatest efficiency, in the least amount of time.

· Prepares for and coordinates credentialing audits in compliance with Elite DNA’s delegated credentialing contracts.

· Oversees the supervision of personnel, which includes work allocation, training, promotion, enforcement of internal procedures and controls, and problem resolution; evaluates performance and makes recommendations for personnel actions; motivates employees to achieve peak productivity and performance.


Requirements:

KNOWLEDGE, SKILLS, AND ABILITIES

  • 5 years of experience in Behavioral Health provider credentialing.
  • 3 years of management experience in credentialing.
  • Knowledge of delegated credentialing workflows.
  • Understanding of HIPAA regulations.
  • Ability to supervise and train employees.
  • Working knowledge of all major payers.
  • Ability to work under pressure while successfully meeting deadlines.
  • A positive, open, and friendly attitude to colleagues and clients.
  • Excellent organization, time management, and prioritization skills required.
  • Research capabilities when confronted with an issue.
  • Proficient with Microsoft Office suite.
  • Strong attention to detail and speed while working within tight deadlines.
  • Exceptional ability to follow oral and written instructions.
  • A high degree of flexibility and professionalism
  • Excellent organizational skills
  • Outstanding communications skills; both verbal and written

EDUCATION/Experience:

· Bachelor’s degree in healthcare management, Business Management, or related field.

· Experience with Athena practice management system.

· Experience managing Behavioral Health credentialing.

· Strong Microsoft Office skills in Excel, Outlook, and Teams.


This position earns competitive compensation plus a full benefits package including medical, dental, vision, and life insurance, annual PTO of 15 days with tenure recognition incentives, one additional paid day for your birthday and Employee Assistance Program. We also offer opportunities for growth, as well as a great team atmosphere that empowers you to take ownership of outcomes in providing quality service and support.

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