Manager Credentialing

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 progresses 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, Credentialing
• Work closely with RCO, Ops, and finance to communicate new providers, site onboarding, and potential revenue impacts as they relate 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 BA
• Minimum 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 preferred
  
  

USD $73,000.00/Yr. USD $85,000.00/Yr.