Database developer h1.location_city

Job Type

Full-time

Description

Job Summary

The Contracting & Credentialing (C&C) Manager, under the supervision of the RCM Manger, working under the Director of Finance, is responsible for overseeing all provider and facility licensing, credentialing, and contracting across all applicable regions and health plans, including management of the C&C team members (Supervisor, Specialists, Coordinators). The C&C Manager will work cooperatively with many teams including Billing, HR, Recruiting, Providers, Operations, and the Owners, to ensure timely and accurate contracting and credentialing to meet staffing and facility needs in a rapidly growing organization.

Essential Functions (not all inclusive)

• Manage all essential functions performed by C&C team members, including Supervisor, Specialists, and Coordinators.
• Manage and lead day-to-day activities of staff who process credentialing and recredentialing applications for health care providers.
• Daily oversight and monitoring of employees' workload and various credentialing workflows (i.e. onboarding, credentialing, EPCS and e-prescribe, provider and facility enrollments).
• Oversee all C&C tasks and duties and ensure each has a corresponding Standardized Operating Procedure (SOP).
• With guidance from the RCM Manager and Director of Finance, interview, hire, and provide a training plan for new staff on credentialing and recredentialing policies and procedures; also provide ongoing training and guidance as needed regarding new guidelines or updated processes and policies.
• Directly oversee C&C employees, their overall performance, and take action when performance issues arise and follow ups are needed, such as disciplinary coaching, performance documentation and/or termination.
• Implement department procedures to facilitate organized and up to date provider databases.
• Oversee periodic audits of credentialing files and staff deliverables.
• Oversee system for tracking license and certification expirations to ensure renewals are submitted in a timely manner.
• Manage team to ensure they monitor external credentialing databases including CAQH, PECOS, and other agencies to ensure data is updated and ready for quick retrieval.
• Manage application processes to ensure they are properly verified and accurately uploaded into an online credentialing database system.
• Manage and resolve complex questions regarding credentialing or provider database maintenance and best practices.
• Prepare and/or oversee reports on applications and credentialing statuses to identify trends and improve the credentialing process.
• Oversee and manage all provider and facility licensing, credentialing, and contracting necessary to ensure claims are paid and cash flow is not disrupted.
• Develop and oversee licensing, credentialing, and contracting workflows and processes as we scale our clinical team across California and potentially other states.
• Manage and oversee maintenance and accuracy of tracking databases of required provider and facility licenses, certifications, contract statuses, and credentials; in addition, review critical data and the associated documents on an ongoing basis to ensure compliance.
• Manage C&C team members to ensure AUC's provider roster is current and accurate to mitigate risks associated with growth, drive efficiencies, and advance proactive monitoring and action related to licensing, credentialing, and contracting.
• Manage communication of provider and plan statuses, along with barriers related to operational processes, and drive solutions to overcome challenges.
• Ensure the C&C team is providing contracting and credentialing support to various departments, teams, and individuals within the organization as needed to fulfill business needs.
• Partner with various health plan representatives to promptly follow up and execute provider and plan approval dates.
• Manage and organize payer contracts, track and monitor all executed health plan agreements, to ensure all active agreements are accounted for and reconciled in an easy to retrieve system. Work with the RCM Manager to ensure claims are billed correctly per the executed agreements.
• Work directly with the RCM Manager to ensure new health plan contracts and their associated effective dates are communicated to the appropriate Operations Managers for staff notification and education purposes.
• Oversee the communication of new providers as they are onboarded to the Billing Team, to ensure claim reimbursements are maximized.
• Manage the team to ensure new provider credentialing is being performed in a timely manner, which includes sending welcome emails to new providers. In addition, ensure the team is assisting the providers with any questions or concerns they may have. Work with team members to trouble shoot barriers quickly to avoid delays in receiving credentialing approvals.
• Manage the team and the professional liability application process, ensure the application and approval process is efficient and timely. If not efficient and timely, investigate and identify root cause problems to recommend solutions.
• Manage the C&C team to ensure the Supervising Physician matrix and associated mid-level agreements are in place and up to date, to remain in compliance with the Medical Board and health plan requirements.
• Manage the C&C team and submission of Letters of Intent to health plans or medical groups that we are not yet contracted with; educate and build relationships with health plan groups to help expedite the contracting process.
• Manage and foster relationships with Health Plan/Insurance contacts to expedite credentialing processes, negotiate rates, and communicate or resolve issues related to contracting or credentialing statuses.
• Manage and oversee the contracting and credentialing of all new facilities, to ensure new clinics are contracted by their assigned go live date.

Requirements

• 7+ years of licensing, credentialing, and contracting experience with a variety of providers (MD, DO, NP, PA) and plan types (Medi-cal, Medicare, HMO, PPO, etc), preferably in an urgent care setting.
• Previous management experience with progressive growth demonstrated.
• High school diploma or equivalent.
• Bachelor's Degree (preferred).
• Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) (preferred)

Salary Description

$32.00 - $39.00