Manager, Credentialing Jobs

ArchWell Health is a new, innovative healthcare provider devoted to improving the lives of our senior members. We deliver best-in-class care at comfortable, accessible neighborhood clinics where seniors can feel at home and become part of a vibrant, wellness-focused community. Our members experience greater continuity of care, as well as the comfort of knowing they will be treated with respect by people who genuinely care about them, their families, and their communities. ArchWell Health requires all new hires to provide proof that they are fully vaccinated from COVID-19, or represent that they will be fully vaccinated within 30 days of their start date.
Job Summary: The Manager, Credentialing will oversee the credentialing function at ArchWell Health. This role will lead a team of analysts to provide guidance and oversight of credentialing new providers and maintaining current provider files for our quickly growing medical group. This hire will oversee the end-to-end credentialing process, including: submitting and tracking credentialing applications to various contracted managed care plans and government payors for oncoming providers; validating the accuracy of provider data loads in payor networks; maintaining accurate and updated data for all providers within the group; tracking the expiration of certification and licenses; support the markets with timely and accurate communications related to provider credentialing and provider data loads; and will act as a liaison between market leadership, payors, external credentialing service firms, and medical staff, including physicians. Duties/Responsibilities: • Evaluate and improve the ArchWell Health credentialing workplan and processes, including all required credentialing for providers and facilities as dictated by government payors and contracted managed care plans • Provide leadership and guidance to Credentialing Analysts • Collaborate cross-functionally with Market Operations, Human Resources, Providers, and IT to ensure providers are credentialed and onboarded in a timely manner • Oversee all necessary credentialing for providers and facilities, including: o.
Conducting background checks p. Contacting licensing boards q. Reviewing license applications r. Obtaining education information s.
Completing references t. Ensuring the facility is operating within state and federal regulations • Regular status reporting to key stakeholders on credentialing and provider directory loads for providers • Reconciliation and timely updates for payor provider data and provider directories to ensure that directories are accurate to support member empanelment required under risk contracts with payors. • Own payor reporting, including data reporting and monthly exclusion checks • Oversee ongoing renewals for all required physician licenses and credentials • Act as a liaison between government payors and managed care plans, outsourced credentialing services, and ArchWell Health medical staff, including physicians • Additional duties as assigned Required Skills/Abilities: • Strong understanding of Medicare, Medicaid, and managed care plan credentialing requirements, plus familiarity with CAQH (Council for Affordable Quality Healthcare) • Ability to build strong cross-functional relationships within an organization to drive projects and initiatives to completion • Ability to partner and communicate with providers in a professional manner to assist in the completion of the CAQH applications Demonstrated track record of successfully executing in a high growth environment with limited infrastructure Strong organization and written communication skills Ability to communicate well with all levels of staff, providers, and patient referral sources Education and Experience: • Bachelor’s degree preferred, or equivalent experience • Minimum of five (5) years of relevant credentialing and enrollment experience, with at least two (3) years in a management role leading people • Prior experience supporting credentialing of providers in a multi-site and multi-state healthcare delivery organization. • Strong PC skills • Embodies and serves as a role model of ArchWell Health’s Values: o.
Be compassionate p. Strive for excellence q. Earn trust r. Show respect s.
Stay resilient t. Always do the right thing ArchWell Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected classification.