Manager - Credentialing Operations

September 25

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Andros

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Medical Credentialing Software • CVO • Credentialing Verification Orgainzation • Direct Medical Credentialing • Delegated Medical Credentialing

51 - 200

Description

• Manage the day-to-day of all credentialing workflows and processes • Manage queues of Primary Source Verification tasks and ensure that all are being delivered within required SLAs. • Perform root cause analysis, establish response plans for how to get back on track, and develop plans to optimize processes to address identified problems. • Maintain insight into team capacity and plan for management of forecasted workload • Train and enhance the oversight of contractual development, including SLAs and SOWs that deviate from our standard offering • Implement new systems as our service offering and product software solutions grow • Partner with our Operations Excellence Team and other key stakeholders, as well as with a BPO teams of outsourced agents performing on data entry, document review, and data processing • Identify inefficiencies and credentialing gaps to key stakeholders and relevant teams in order to find solutions to ensure compliance • Facilitate cross-team communication and collaboration with our Success and Support Teams by serving as the face and voice of credentialing knowledge at Andros • Work closely with the Client Success team to ensure client concerns are incorporated into our credentialing solutions • Update client success managers and support on changes to the primary source verification process and platform • Create systems and processes that are easily understood by clients and key stakeholders • Partner with client support to reduce the number of requests and client escalation • Be a supportive resource to product, engineering teams and sales teams for R&D and productization of overall credentialing best practices • Attend meetings with P&E to promote product dialogue • Identify pain-points that can attribute to better product development of our solutions • Grow and nurture an effective team • Encourage, develop, and train a culture that focuses on solution-oriented problem solving • Coach employees and build operational capabilities of the Credentialing Andros team • Accurately plan and forecast workload for current and upcoming projects for teams capacity • Position the right people to be doing the right work at the right time

Requirements

• BA/BS in relative field required • 5+ years of credentialing experience for practitioner and organizational • In-depth knowledge of medical credentialing processes, primary source verification (PSV), and compliance with regulatory standards (e.g., NCQA, URAC, Medicare, Medicaid and state credentialing requirements.) • 3+ years of directly managing a credentialing team • Experience with document management, SOP and training cultivation • Experience in PNO (Provider Network Operations) provider relations, provider credentialing, health plan network implementations