Manager Credentialing
JOB_DESCRIPTION.SHARE.HTML
CAROUSEL_PARAGRAPHJOB_DESCRIPTION.SHARE.HTML
United StatesSurgical Care AffiliatesNetwork ManagementRegularFull-time1USD $73,000.00/Yr.USD $85,000.00/Yr.38930SCA Health
Job Description
Overview
Today, SCA Health has grown to 14,000 teammates who care for over 1 million patients each year and support physician specialists holistically in many aspects of patient care. Together, our teammates create value in specialty care by aligning physicians, health plans and health systems around a common goal: delivering on the quadruple aim of high-quality outcomes and a better experience for patients and providers, all at a lower total cost of care.
As part of Optum, we participate in an integrated care delivery system that enables us to support our partners as they navigate a complex healthcare environment, Only SCA Health has a dynamic group of physician-driven, specialty care businesses that allows us to customize solutions, no matter the need or challenge.
Responsibilities
The
Practice
Credentialing Manager
is responsible
for
managing the verification of qualifications, certifications, and licenses of healthcare providers to ensure they meet the necessary standards for providing care.
This individual will act as the liaison
with
clinicians,
ensuring the team completes
timely
submission and
accurate
management of credentialing applications, recredentialing processes, and
maintaining
records and documentation.
The role demands
a high level
of organizational skills, attention to detail, and the ability to adapt to changing requirements from funding sources and government regulations.
Essential Duties and Responsibilities:Serve as the main point of contact with clinicians.Oversee the credentialing process and
ensure standardization across all practice divisions.Manage the
completion of
primary source verification of education, training, board certification, work history, and licensure of healthcare providers.Ensure ongoing accuracy of credentialing information, including updating provider rosters per division and funding source.Support and communicate with internal teams to
facilitate
the
onboarding
and
offboarding
of physicians/
providers.Manage the
completion of new practice
locations
to providers and/or divisions.Manage monthly reporting on credentialing progress
es
and team’s
productivity.Maintain
accurate
and confidential credentialing databases and files,
ensuring
the
utilization
of the
credentialing
system
and
accuracy of data
for comprehensive tracking
.Monitor
payer credentialing and enrollment
to ensure compliance with various
payer
standards, policies,
and requirements to
maintain
Participating status with commercial and government
payers.Set
priorities for the team and
measure standards
to track
success.Communicate project barriers, downstream impacts, and resolution plans to
the Sr. Director, CredentialingWork closely with RCO, Ops, and finance to communicate new providers, site onboarding, and potential revenue impacts as they relat
e
to Credentialing and Payer Enrollment.Manage and/or
assist
with training of new employees as business needs increase.
Qualifications
The
minimum
requirements and preferences are listed below:
High School/GED
required
. Prefer college course work of BAMinimum of 3 years’ experience working in a physician office, hospital, or managed care organization.5-7 years of experience in credentialing or equivalent work experience
required
.Excellent communication and interpersonal skills to effectively interact with all levels of staff and external partners.MD Staff Software knowledge preferredUSD $73,000.00/Yr. USD $85,000.00/Yr.
PI443f4a70e269-35216-36915621