Credentialing Manager

About Advantmed:

At Advantmed our mission is to improve the healthcare system by ensuring appropriate, quality care, and eliminating unnecessary costs. Advantmed is a leading provider of risk adjustment, quality improvement and value-based solutions to health plans and providers. We drive market leading performance with integrated technology, service, and program solutions that optimize the risk and quality performance of our partners. Our solutions focus on identifying, managing, and documenting risk and quality performance, and the proactive clinical engagement of high acuity populations.

Primary Purpose:

We are seeking a highly skilled and experienced Credentialing Manager to oversee our credentialing process and ensure that our organization complies with all relevant regulations and guidelines. The ideal candidate will have NCQA certification experience and a proven track record of success in managing a credentialing program.

Job Roles and Responsibilities:

• Manage the credentialing process for healthcare providers, including initial credentialing, re-credentialing, and ongoing monitoring.
• Manage and monitor credentialing team performance, providing regular feedback and coaching to team members to ensure continuous improvement
• Oversee the company’s NCQA certification process.
• Develop and manage the credentialing program for the organization.
• Develop and maintain policies and procedures related to credentialing.
• Provide training to staff on credentialing policies and procedures.
• Conduct credentialing audits to ensure compliance with regulatory requirements and NCQA standards.
• Maintain accurate and complete credentialing files.
• Participate in the development and implementation of quality improvement initiatives related to credentialing.
• Stay up-to-date with changes in regulations and guidelines related to credentialing.
• Provide regular reports to leadership on the status of the credentialing program.
• Collaborate with other departments to ensure that credentialing information is accurate and up-to-date.

Requirements

• Bachelor's degree in healthcare administration, business administration, or a related field preferred.
• NCQA certification is required.
• Minimum of 5 years of experience in healthcare credentialing, with at least 3 years in a management role.
• Strong understanding of NCQA standards and accreditation process.
• Excellent organizational and time management skills.
• Strong analytical and problem-solving skills.
• Excellent communication and interpersonal skills.
• Ability to work collaboratively with internal and external stakeholders.

Benefits

• Medical - Dental - Vision
• 401k
• PTO
• Paid parental leave