Manager Provider Credentialing - Credentialing - INTEGRIS
Company: INTEGRIS Health
Location: Oklahoma City
Posted on: April 8, 2021
Manager Provider Credentialing
Job Code: 8334
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
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
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
* 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
* 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
* 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)
* Provides monthly updates during the IMG Manager meeting.
Reports to the System Administrative Director of Provider
Contracting and Onboarding
Required Physical Demands (Subject to Reasonable
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
Strength (Lift/Carry/Push/Pull): Sedentary (exerting up to 10
pounds of force occasionally)
Talking (Must be able to effectively communicate verbally): Yes
Color Acuity (Must be able to distinguish and identify colors):
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.
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.
* Bachelors Degree in Business, Healthcare Administration or
* 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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