Assistant Director

5 days ago

Red Bank, New Jersey, United States Physicians Practice Enhancement LLC Full time
Job Title: Assistant Director

We are seeking an experienced Assistant Director to join our provider enrollment and credentialing team at Physicians Practice Enhancement LLC.

Job Summary

The Assistant Director will work closely with the Director of Operations to coordinate and supervise the work of all employees. This role requires strong leadership and organizational skills, as well as the ability to manage multiple priorities and deadlines.

Key Responsibilities
  • Assist in department's work queues and tracking reports to ensure timely submission of credentialing documents
  • Screening practitioners' applications and supporting documentation to ascertain their eligibility
  • Collecting information from the National Practitioner Data Bank (NPDB), the applicant and their malpractice insurer, and other Primary Source Verifications
  • Ensuring all information is entered in our data system accurately and in a timely manner
  • Assist with NCQA recertification process
  • Develop and implement standardized guidelines
  • Provide leadership, training, and review credentialing to assist in the evaluation performance of credentialing leads and specialists
  • Manage, identify, research, resolve, and report any issues involving daily workflow and quality of work to the Director of Operations
  • Work with Director of Operations to ensure compliance guidelines are established consistently throughout organization
  • Participate in and/or support the Orientation of newly hired staff members
  • Maintain both internal and external customer and client relationships as required and manages expectations related to the performance of deliverables and non-standard issue resolution
  • Maintain compliance with Federal and State regulations
  • Assist in conducting weekly, bi-weekly, monthly credentialing calls with clients and team member
  • Budget Management for department
  • Process Improvement for department
  • Assist in training of new hire staff
  • Oversee credentialing data needed for onboarding, contracting, and other related purposes. Credentialing data includes but is not limited to the medical degree, Drug Enforcement Administration (DEA) number, state license number, Board certifications, malpractice insurance and state insurance form
  • Work closely with providers and practice managers to obtain missing documentation pertaining to the onboarding and reappointment process. Obtains required provider signatures and follows up with the entities on documentation submitted
  • Maintain provider information and demographics for all providers
  • Responds to internal and external inquiries on routine credentialing and contracting matters
  • Monitors and advises clients on expirations including but not limited to: Medical License, DEA, CDS, COI, Board Certification
  • Maintain quarterly health plan rosters
  • Create & maintain provider CAQH
  • Maintains workflow processes for all commercial and government payors
Requirements
  • Credentialing: 7 years (Preferred)
  • Provider Enrollment: 7 years (Preferred)
  • Microsoft suites (Excel, Outlook) 5 years (Preferred)
  • Managed Health Plan Provider Enrollment: 3 years (Preferred)
  • Leadership: 3 years (Preferred)
  • National Committee for Quality Assurance (NCQA) Standards, state regulations, and Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards (Preferred)
  • Credential Stream platform
  • PECOS: 5 years (preferred)

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