Manager - Credentialing

Credentialing Manager 

Position Description 

Scottsdale, AZ (Onsite)

Position Summary  

The purpose of this position is to provide credentialing expertise to the physician and advanced practice professional personnel as well as the service units for which they are credentialed. Accountable for the organization, maintenance, and verification of all aspects of the credentialing and licensing processes for healthcare providers.  

Primary Function  

The Credentialing Manager manages the successful onboarding and continual verification of physicians and advanced practice professionals’ credentials at each location. Serves as liaison between each hospital’s credentialing department and Tribal Health. 

Position Responsibilities 

• Prepare reports of credentialing activities such as accreditation, licensing and facility privileges.
• Maintain all necessary databases and applications used for input of new information and updates existing information.
• Create and develop processes to ensure a streamlined credentialing process.
• Establish a positive and collaborative relationship with a customer service focus for incoming provider as they credential and onboard with Tribal Health.
• Review facility-specific rules and regulations to ensure constant compliance with all internal processes.

• Knowledge of CMD and credentialing programs and verification sites.
• Verify healthcare credentials using primary source verification including but not limited to conduct necessary background checks, contact licensing boards, review license applications and obtain education and prior work history information and references.
• Update bi-weekly credentialing update report and send to applicable IHS and Tribal Health staff.
• Responsible for developing and maintaining positive, professional, collaborative relationships with clients and ensuring customer satisfaction.  
• Knowledge of related accreditation and certification requirements.
• Work with service units, communicate, and problem solve to ensure compliance with all aspects of the client contract.
• Knowledge of contract requirements in regard to provider eligibility and requirements.
• Oversee and manage the Credentialing Support Coordinator.
• Function as a resource including mentoring/coaching other team members.
• Attend meetings as requested or required by service unit administration and/ or Tribal Health.

Other Responsibilities 

• Assist CMO with OPPE/FPPE overview and tracking
• Assist when provider scheduling as needed
• Coordinate with 3rd party staffing agency contracts, provider staff on boarding, invoice review and approval
• Data Matrix
• Other duties as assigned

Minimum Mandatory Qualifications 

Experience: 

• Minimum of 5 years of experience directly related to hospital medical staff or managed care credentialing
• Minimum of 2 years of supervisory or management level experience in credentialing

Education: 

• Associated degree in business or related field preferred; Minimum of a high school diploma or GED required.

License/Certification: 

• Certification/Licensure NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS) preferred

Knowledge, Skills, Abilities and Other Qualifications  

• Proficient use of Microsoft Office (Word, Excel and PowerPoint) and Google docs.
• Demonstrated ability to communicate verbally and in writing throughout all levels of the organization, both internally and externally.
• Strong consultative skills and leadership experience.
• Ability to work well as a cooperative and supporting member of the team.
• Ability to concentrate and pay close attention to detail when reviewing financial data.
• Knowledge of, and sensitivity to, cultural and language differences. 
• Excellent interpersonal skills in handling interactions with operational staff, providers, other agencies, groups, and team members.
• Must be able to work as a team member and develop productive and cooperative working relationships with all members of the health care team.

• A record of satisfactory performance in all prior and current employment as evidenced by positive employment references from previous and current employers.
• Ability to perform other duties as assigned.

Native American Preference: Preference in filling vacancies is given to qualified Native American candidates in accordance with federal law (Title 25, USC Section 472). Form BIA-4432 should be submitted with the application. For more information about Native American Preference in employment please click here. 

Equal Opportunity Employer: Tribal Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. We value the skills, experience, and dedication that veterans bring to the workplace and qualified veterans are encouraged to apply. Tribal Health is also committed to providing reasonable accommodations for qualified individuals with disabilities and disabled veterans in our job application procedures. If you need assistance or an accommodation due to a disability, please let us know by emailing hr@tribalhealth.com or by calling (480)581-6961. For more info on EEOC please visit EEOC KNOW YOUR RIGHTS 

Work Environment 

Physical demands: 

The physical demands described here are representative of those that must be met by an employee to successfully perform the primary functions of this job. While performing the duties of this job, the employee may be required to frequently stand, walk, sit, bend, twist, talk, hear and perform repetitive motions. There may be prolonged periods of sitting, keyboarding, reading, as well as driving or riding in transport vehicles. Specific vision abilities required by this job include reading, distance, computer, and color vision. Talking and hearing are essential to communicate with clients, vendors and staff. Overnight travel may be required from time to time. 

Mental demands: 

There are a number of deadlines associated with this position. The employee must be able to handle frequent interruptions and must also multi-task and interact with a wide variety of people on various and, at times, complicated issues. 

Other: 

Confidentiality: 

All employees must uphold all principles of confidentiality and patient care to the fullest extent. This position has access to sensitive information and a breach of these principles will be grounds for immediate termination 

Background Investigation: 

This position may be subject to a 101-630 background check in an effort to ensure compliance with public law 101-630 “Indian child protection and family violence prevention act.” Candidates for positions that require a 101-630 background check must be able to successfully pass a background and character investigation in compliance with pl 101-630. 

Drug Screening: 

All applicants must successfully pass a pre-employment drug screening prior to beginning employment and will be subject to random drug testing. 

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