Credentialing and Contracting Manager – Pittsburg, Kansas


GENERAL DESCRIPTION

This position has responsibility of supervising and directing the work of the compliance/credentialing team.  This position is responsible for overseeing the processing of the credentials and privileges of all providers in order to verify accuracy and compliance with state and federal regulations, and HRSA and FTCA deeming requirements.  This position ensures the maintenance of the database of practitioners' training, education, licensing.  This position ensures provider/facility applications are submitted to payers and is responsible for credentialing providers through third party payers.

ESSENTIAL DUTIES

  • Manages and directs the work of the credentialing/contracting staff through the credentialing process, both internally and with payers.
  • Ensures that staff are knowledgeable of and adheres to CHC/SEK’s Credentialing and Privileging Policy and Procedure, and ensures process is completed timely.
  • Supervises credentialing/contracting staff including, but not limited to hiring, discipline and performance evaluations.
  • Assists with the credentialing and/or contracting processes to ensure timely applications are submitted.
  • Addresses problems with payers regarding timeliness of approvals and works with the payer to find a resolution.
  • Communicates credentialing findings to supervisor.
  • Obtains Chief Clinical Officer’s approval of credentials and requested privileges prior to submission for Board of Directors approval.
  • Responsible for accurate and complete credentialing file for all providers. Files are kept confidential and secure.
  • Submits accurate and complete application information to payers to receive billing number to allow submission of claims for facilities and providers.
  • Responsible for ensuring that third party payer contracts are signed by all parties necessary to ensure appropriate plan enrollment.
  • Completes EFT and ERA enrollment as part of the enrollment process to ensure electronic payments and claims submissions.
  • Track progress of licensing requirements for providers as a part of payer enrollment.
  • Actively communicates with applicants, employment references and others as necessary to ensure timely completion of the credentialing and contracting process.
  • Perform all duties, services and documentation in full compliance with CHC/SEK policies and procedures.
  • Performs other duties as assigned.

QUALIFICATIONS

  • High school diploma or equivalent required.
  • Any combination of education and work experience that would likely provide the required knowledge and abilities is qualifying