Credentialing Manager
10 days ago
Cambridge
Job Description We are seeking a Credentialing Manager! Southeastern, OH (Virtual role) Integrated Services for Behavioral Health (ISBH) is a community-minded, forward-thinking behavioral health organization helping people along the road to health and well-being. We meet people in their homes and communities and help connect them to the resources they need. We serve Southeastern and Central Ohio with a comprehensive array of behavioral health and other services, working with local partners to promote healthy people and strong communities. All of our services are intended to be collaborative and personalized for the individual. The Credentialing Manager is responsible for overseeing all provider credentialing, recredentialing, payer enrollment, and provider data management activities for Integrated Services for Behavioral Health (ISBH). This role ensures providers maintain active participation with Medicaid, Medicare, commercial insurance plans, and other payer organizations while maintaining compliance with federal, state, accreditation, and payer-specific requirements. The Credentialing Manager supervises credentialing staff, develops and improves credentialing processes, monitors key performance metrics, and collaborates with internal and external stakeholders to ensure uninterrupted provider enrollment and reimbursement. The salary for this position is $87,000.00 to $108,000.00 annually, based on experience Essential Functions • Oversee all provider credentialing, recredentialing, payer enrollment, and provider maintenance activities for ISBH, • Manage the credentialing team and coordinate daily workflow to ensure the timely completion of credentialing activities, • Responsible for performance management, recruitment, onboarding, and team development, including but not limited to implementing progressive discipline when necessary, • Ensure timely submission, tracking, and follow-up of credentialing and recredentialing applications to prevent lapses in provider participation, • Maintain provider credentialing files and databases, ensuring all licenses, certifications, registrations, and other required documentation remain current., • Monitor provider enrollment status with Ohio Medicaid, Medicare, commercial payers, and other contracted entities, • Serve as the primary resource for resolving complex credentialing and payer enrollment issues, • Ensure compliance with federal, state, accreditation, and payer-specific credentialing requirements, • Develop, implement, and maintain credentialing policies, procedures, and quality assurance standards, • Monitor credentialing performance metrics and identify opportunities for process improvement and operational efficiency, • Collaborate with billing, compliance, human resources, clinical leadership, and provider relations teams to support organizational goals, • Maintain expertise in credentialing regulations, payer requirements, provider enrollment processes, and industry best practices, • Coordinate credentialing activities related to new programs, services, locations, and revenue streams, • Participate in audits, accreditation reviews, and compliance activities as required, • Attend virtual and in-person internal and external training, conferences, and meetings as appropriate, • Maintain compliance with HIPAA, mandated reporting requirements, and professional ethical guidelines, • Travel within the designated service area, • Perform other duties as assigned Minimum Requirements: Education/Licensure: • A high school diploma or GED equivalent is required, • A bachelor’s degree in business, Public Health, Healthcare Administration, or a related field is preferred Experience: • 5 years of experience in provider credentialing and payer enrollment in a healthcare setting is required, • 3 years of supervisory or management experience in a healthcare credentialing role is required, • Experience with Ohio Medicaid provider enrollment and credentialing is required, • Experience working with credentialing systems and electronic health records is required, • Experience utilizing NPPES, CAQH, Ohio Medicaid PNM, and payer enrollment portals is required Knowledge, Skills, and Abilities: • Knowledge of credentialing standards, provider enrollment requirements, and healthcare regulatory compliance, • Ability to manage multiple projects, deadlines, and priorities independently, • Advanced analytical, organizational, and problem-solving skills, • Proficiency with databases, spreadsheets, and Microsoft Office applications, • Advanced communication skills, both oral and written is required, • Advanced organizational skills are required, • Knowledge of local, state, and federal regulations is required, • The ability to maintain confidential information is required, • Ability to adhere to all safety rules, regulations, and requirements, • A valid driver's license and the ability to operate a motor vehicle are required, • An appropriate level of auto insurance coverage is required, • Ability to manage deadlines within a fast-paced, high-volume environment is required, • The ability to operate in an Internet-based, automated office environment is required, • The ability to maintain a high-speed internet connection is required Physical Requirements • Prolonged periods of sitting at a desk and working on a computer, • Must be able to lift up to 15 pounds occasionally Enjoy a great work environment with an excellent salary, generous paid time off, and a strong benefits package. Benefits include: • Medical, • Dental, • Vision, • Short-term Disability, • Long-term Disability, • 401K w/ Employer Match, • Employee Assistance Program (EAP) provides support and resources to help you and your family with a range of issues. To learn more about our organization: https://ISBH.org/ OUR MISSION Delivering exceptional care through connection OUR VALUES Dignity - We meet people where they are on their journey with respect and hope Collaboration - We listen to understand and ask how we can best support the people and communities we serve Wellbeing - We celebrate one another's strengths, and we support one another in being well Excellence - We demand high-quality care for those we serve, and are a leader in how we care for one another as a team Innovation - We deeply value a range of perspectives and experiences, knowing it is what inspires us to stretch past where we are and reach towards what we know is possible The above list of duties is intended to describe the general nature and level of work performed by individuals assigned to this position. It is not to be construed as an exhaustive list of duties performed by the individuals in this role, nor is it intended to limit or modify the right of any supervisor to assign, direct, and control the work of employees under their supervision. We’re an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.
