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Manager Provider Credentialing - Credentialing - INTEGRIS

Company: INTEGRIS Health
Location: Oklahoma City
Posted on: April 8, 2021

Job Description:

Manager Provider Credentialing

Job Code: 8334

Position Summary:

Opportunity for an individual experienced in hospital medical staff and provider insurance credentialing to further develop the business growth for delegated credentialing with insurance payors. Leadership and business development skills will be essential to collaborate with medical group and insurance contracting leadership.

The Manager of Provider Credentialing is responsible for all aspects of the credentialing, recredentialing and privileging processes for all medical providers who provide patient care at INTEGRIS. Manager assures the credentialing of providers throughout INTEGRIS Medical Group (IMG) and other INTEGRIS Health entities will meet NCQA guidelines for credentialing and IMG standards of quality. Manager oversees the centralized enrollment and privileging for INTEGRIS employed providers. Previous experience to include work experience with hospital medical staff credentialing and Joint Commission standards, preferred

INTEGRIS Health is an Equal Opportunity/Affirmative Action Employer.

Essential Functions:

The Mgr Provider Credentialing IMG responsibilities include, but are not limited to, the following:

* Develops provider enrollment and credentialing process so there is one point of contact for providers to streamline credentialing and ensure providers are productive, able to practice and bill upon employment start date.

* Manages and directs department staff, including hiring, evaluating performance and competency, and conducting disciplinary/counseling sessions as needed.

* Works with managed care provider relations staff to resolve payer issues.

* Provides leadership to credentialing and enrollment staff who serves as liaison to medical service providers to resolve issues and problems and maintain positive relationship with provider practices.

* Oversees credentialing of providers utilizing NCQA and URAC guidelines, maintains credentialing files including medical license, DEA, malpractice faces sheets, etc., tracks licensure and certification to ensure timely renewals and processes applications for appointment/reappointment of privileges for IMG, IHP, and hospital privilege packets.

* Facilitates hospital staff privilege process for IMG providers as well as Nazih Zuhdi Transplant Institute (NZTI), Great Plains, Lakeside Women's Hospital, INTEGRIS Mental Health-Spencer, and Cochlear Implant Clinic.

* Manages a centralized, efficient, computer based provider management system for enrollment and credentialing.

* Develops and administers payer credentialing and enrollment policies and procedures.

* Develops education content for clinic staff about payor coverage guidelines, referral process, updates, changes and overall program requirements.

* Oversees initial and reappointment of INTEGRIS Health Partners (IHP) credentialing as well maintenance of provider files.

* Manages credentialing and re-credentialing applications; monitors applications and provides follow-up as needed.

* Maintains copies of current state licenses, DEA certificates, malpractice coverage, and any other required credentialing documents for all providers.

* Maintains provider insurance credentialing file.

* Maintains knowledge of current health plan and agency requirements for credentialing providers.

* Manages practice address log to ensure all practice locations are current with health plans, agencies and other entities.

* Participates monthly with the IHP Strategy committee.

* Participates monthly with the Physician Advisory Council (PAC) committee.

* Provides monthly updates during the IMG Manager meeting.

Accountability:

Reports to the System Administrative Director of Provider Contracting and Onboarding

Required Physical Demands (Subject to Reasonable Accommodation):

Keyboarding/Dexterity: Frequently; activity exists from 1/3 to 2/3 of the time
Standing/Walking: Occasionally; activity exists up to 1/3 of the time
Strength (Lift/Carry/Push/Pull): Sedentary (exerting up to 10 pounds of force occasionally)
Talking (Must be able to effectively communicate verbally): Yes
Seeing: Yes
Hearing: Yes
Color Acuity (Must be able to distinguish and identify colors): No

This position may have additional or varied physical demand and/or respiratory fit test requirements. Please consult the Physical Demands Project SharePoint site or contact Risk Management/Employee Health for additional information.

Environmental Conditions:

Normal Office conditions.

This position requires monthly travel to INTEGRIS regional facilities, including Enid, Miami and Grove

All applicants will receive consideration regardless of membership in any protected status as defined by applicable state or federal law, including protected veteran or disability status.

Qualifications:

* Bachelors Degree in Business, Healthcare Administration or related field

* 4 years of progressive professional experience in provider relations, managed care contracting, provider enrollment and/or credentialing to include experience

* 4 additional years of progressive professional experience in provider relations, managed care contracting, provider enrollment and/or credentialing accepted in lieu of Bachelors degree

* Previous experience in a supervisory capacity preferred

* Previous work experience with Medicare Provider Enrollment regulations, laws, and rules

* Previous work experience with NCQA guidelines preferred.

* Previous work experience with managed care, credentialing, and provider enrollment preferred.

Keywords: INTEGRIS Health, Oklahoma City , Manager Provider Credentialing - Credentialing - INTEGRIS, Executive , Oklahoma City, Oklahoma

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