Returning Candidate? Log back in! Credentialing Director Location US-TN-Franklin ID 2024-1582 Category Management Position Type Full-Time Overview

Join Our Impactful Team at Health Connect America! 

At Health Connect America, we are dedicated to making meaningful connections every day by fostering growth, belonging, and wellness for our teammates while providing vital mental and behavioral health services to our community. Our mission is to create quality, affordable opportunities for individuals and families to achieve their greatest potential in a safe, positive living environment. 

Why Work with Us? 

Grow with Us  

 

We proudly offer an environment for learning and development. As a Council on Accreditation (COA) accredited provider, we are dedicated to providing the highest quality services and fostering professional growth. We offer numerous opportunities for growth and enrichment, including: 

Internal in-home certification programs Training and development programs for leadership and direct care staff Performance management and career planning Continuing education hours Free supervision for therapists seeking professional licensure 

You Belong with Us 

We believe that we are at our best when every member of our team feels respected, included, and heard. We encourage our employees to make suggestions, help us improve, and shape our future direction. Through our PROPS rewards and recognition program, Check-ins using the SigBee app, Diversity & Inclusion initiatives, annual Day of Giving, and our Passion Projects, we foster a sense of connection, belonging, and community. We are committed to sustainability and ethical impact through environmental stewardship, social responsibility, and effective governance. 

Be Well with Us 

At HCA, we recognize the importance of self-care and work/life balance. We offer flexibility in scheduling and provide all employees access to our Employee Assistance Program (EAP), which includes 8 mental health counseling sessions annually. Full-time employees enjoy paid time off, paid holidays, and a comprehensive benefits package that includes health, dental, vision, and other voluntary insurance products. Additional benefits include: Access to a Health Navigator Health Savings Account with company contribution Dependent Daycare Flexible Spending Account Health Reimbursement Account 401(k) Retirement Plan Benefits Hub Tickets at Work 

 

Join a team where your contributions truly make a difference in the lives of others. Apply now to be part of our dynamic and supportive community at Health Connect America! 

Responsibilities

Summary:

The Credentialing Manager plays an integral role within healthcare organizations, overseeing the process that allows medical professionals to practice at healthcare facilities or with insurance networks. This position involves managing the verification of qualifications, certifications, and licenses of healthcare providers to ensure they meet the necessary standards for providing care. By maintaining accurate and up-to-date records, the Credentialing Manager supports the seamless operation of healthcare services, ensuring that only qualified professionals are part of the team. This role requires a meticulous attention to detail and a strong understanding of regulatory compliance, as it serves to uphold the integrity and quality of healthcare delivery.

 

Job Responsibilities:

· Develop and implement policies and procedures for credentialing and recredentialing healthcare providers ensuring compliance with national accreditation standards, state and federal regulations, and payer requirements.

· Develop and implement policies and procedures for the credentialing and recredentialing process, ensuring they meet industry standards and organizational needs.

· Manage the primary source verification of education, training, board certification, work history, and licensure of healthcare providers.

· Facilitate the resolution of discrepancies or concerns regarding applicants’ credentials, working closely with medical staff leadership and healthcare providers.

· Liaise with external agencies, including insurance carriers and regulatory bodies, to ensure the timely sharing of credentialing information and compliance with external standards.

· Manage the credentialing process from initial application through re-credentialing, including primary source verification, background checks, and review of licensure, certifications, education, and work history.

· Responsible for integration of newly acquired entities, including software and staff.

· Collaborate with internal departments, such as Human Resources, and Quality and Compliance to ensure alignment of credentialing processes with organizational goals and objectives.

· Maintain accurate and up-to-date credential files and databases, ensuring confidentiality and security of sensitive information.

· Serve as the primary point of contact for credentialing inquiries from healthcare providers, staff, and external stakeholders, providing timely and accurate responses.

· Monitor and evaluate the performance of credentialing staff, providing guidance, training, and support as needed to ensure high-quality and efficient credentialing processes.

· Stay informed about changes in credentialing requirements, regulations, and industry trends, and make recommendations for process improvements and enhancements.

· Prepare and submit reports on credentialing activities, compliance metrics, and performance indicators to senior management and regulatory agencies as required.

· Participate in audits, surveys, and accreditation reviews related to credentialing, providing documentation, and supporting evidence as needed.

· Represent the organization in meetings, conferences, and industry events related to credentialing and provider enrollment.

Qualifications

Qualifications and Education Requirements:

· Bachelor’s degree in either Healthcare Management, Business Administration, or other related field; Master's degree preferred.

· Certification as a Certified Provider Credentialing Specialist (CPCS) or Certified Professional in Medical Services Management (CPMSM) preferred.

· Minimum of 7 years' experience in healthcare credentialing, with at least 3 years in a leadership or supervisory role.

· In-depth knowledge of credentialing principles, processes, and standards, including NCQA, Joint Commission, and CMS requirements.

· Strong analytical skills with the ability to interpret complex regulations and accreditation standards.

· Excellent communication and interpersonal skills, with the ability to interact effectively with healthcare providers, staff, and external stakeholders.

· Demonstrated leadership abilities, including the ability to motivate and develop a team, foster a culture of accountability and continuous improvement, and achieve performance goals.

· Proficiency in credentialing software and database management systems.

· High level of integrity and discretion in handli

Options ApplyApplySubmit a ReferralRefer Sorry the Share function is not working properly at this moment. Please refresh the page and try again later. Application FAQs

Software Powered by iCIMS
www.icims.com