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Credentialing Manager

Company: USA Clinics Group
Location: Northbrook
Posted on: May 11, 2024

Job Description:

At USA Clinics Group, we use our expertise to provide the best possible service for our patients. Our team members are passionate about making a difference in the lives of the people we treat and are constantly striving to improve and better ourselves so that we can better support our patients and are currently searching for a Credentialing Manager to join our team!As the Credentialing Manager you would be responsible for overseeing the credentialing and re-credentialing process for all providers in 170+ clinics across 30 states.This position works on-site at our Corporate Headquarters located in Northbrook, Illinois!Responsibilities:Processes physician accreditation, managed care, governmental and commercial insurance enrollment and re-credentialingResponsible for daily provider data management and review of credentialing files for accuracy and completeness, utilizing internal and external sourcesResponsible for analyzing clinic utilizations and develop physician location scheduling recommendationsAnalyze local payor IPA markets for partnerships or payer contracting opportunitiesPerforms primary source verification via various state and national sourcesMaintains individual provider credential files with all the appropriate documentation consistent with AAAHC and NCQA standardsOversees, updates and maintains provider credential database including CAQH, PECOS, NPPES Registry, Sharepoint any other applicable regulatory agenciesDevelops and prepares analytical reports monthly/quarterly of the summary of credentialing activityResponds timely to provider inquiries by letter, phone or internal communicationWork closely and maintain relationships with provider relations at each payer, and communicates any challenges and/or concerns with manager timelyMaintain Credentialing Applications for accuracy and completenessWork to develop automation Bots to streamline the applications/Enrollment processAdditional duties as assigned

Keywords: USA Clinics Group, Chicago , Credentialing Manager, Executive , Northbrook, Illinois

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