Credentialing Manager

Knowledge, Skills, Abilities

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The list below are representative of the knowledge, skill and/or ability. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Required:  

• Excellent analytical abilities and communication skills including the ability to communicate with stakeholders and decision-makers across the spectrum of the organization, from senior business leaders to subordinates
• Experience in progressive health care management with emphasis in health plan/provider contracting and physician group management/contracting
• In Depth knowledge of health plan and governmental payer credentialing, enrollment, medical claims payment and requirements.
• Ability to work within a deadline-intense environment. 
• Demonstrated problem-solving and customer service skills. 
• Knowledge of primary source verification, provider enrollment, and NCQA credentialing requirements.
• Proficient working knowledge of Echo or other credentialing systems, Athena and MS Office Suite of products including but not limited to Word, Excel, Project, and PowerPoint.

Preferred:

• Experience with multi-specialty or large group practices across multiple states/Tax IDs
• Bachelor’s degree in healthcare management, public health, accounting, finance, business, social or behavioral sciences preferred or equivalent experience
• 7-10 years of previous managed care experience and 5+ years’ experience in a credentialing leadership role

Education/Experience