Manager of Payer Credentialing - Trinity Health : Job Details

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Description:Serving as a member of the SMMG leadership team, responsible for payer enrollment applications and file maintenance processes for provider and facility billing which includes Medicare, Medicaid, Anthem/BCBS, managed care, and commercial plans. Directs all associated payer credentialing activities across employed and affiliated service lines, locations, and provider functions.

Employment TypeFull timeShiftDescription:Serving as a member of the SMMG leadership team, responsible for payer enrollment applications and file maintenance processes for provider and facility billing which includes Medicare, Medicaid, Anthem/BCBS, managed care, and commercial plans. Directs all associated payer credentialing activities across employed and affiliated service lines, locations, and provider functions.Position RequirementsA: Licensure/Certification/Registration: N/A.B. Education: Bachelor's Degree in Business Administration or Health Administration related field or a combination of education and experience is required.C: Experience: 3 years of experience that is directly related to the payor enrollment duties and responsibilities specified. Previous managerial experience preferred.D. Special Qualifications: Computer Competency: Requires the ability to operate a personal computer to utilize and comprehend a variety of web applications, spreadsheets, and word processing software applications. Must be proficient with Microsoft Office software, including Word and Excel. Ability to use other software as required to perform the essential functions of the job. Medical terminology preferred. The role requires exceptional accuracy relating to data entry of provider information (i.e. demographics, specialty, education, etc.) and the ability to manipulate that data. An understanding of organizational dynamics and administrative procedures and protocols. Ability to function in a dynamic, fast-paced team environment and to cope with ambiguity, time constraints, and other daily stressors in an effective and appropriate manner. Time management, prioritization and organizational skills including demonstration of an ability and willingness to plan, organize and accomplish tasks accurately and in a timely manner to exercise sound judgment under pressure and to manage multiple and competing activities simultaneously. Excellent communication skills including the ability to demonstrate diplomacy and tact, compose, spell, edit/proof, utilize appropriate grammar, and to relate in an appropriate interpersonal manner to all levels and types of individuals in a fashion that will earn credibility, respect, confidence and will generate mutual support. High degree of trust and demonstration of the ability to respect and appropriately handle confidential and sensitive information. Assigned hours within your shift, starting time, or days of work are subject to change based on departmental and/or organizational needs.III. Essential Functions

• Actively demonstrates the organization's mission and core values and conducts oneself at all times in a manner consistent with these values.
• Knows and adheres to all laws and regulations pertaining to patient health, safety and medical information.
• Under the direction of the Vice President of Operations, directs the completion of initial and revalidation applications for payor enrollment; ensures accuracy and completeness of all documentation. Serves as a primary liaison with other offices, individuals, and external institutions and agencies on day-to-day credentialing issues.
• Directs work to ensure timely delivery of high-quality credentialing information and conducts a formally defined quality control and performance improvement process for the credentialing process with periodical reporting to users.
• Ensures timely response to internal and external inquiries regarding status of enrollment applications and file maintenance requests.
• Researches and/or contacts providers to resolve enrollment application and/or file maintenance deficiencies.
• Directs the verification and data entry of information from paper applications and provider submitted documents; validation to ensure the enrollment application meets the minimum standards.
• Establishes, maintains, and updates files, databases, records, and/or other documents related to provider and facility credentialing.
• Attends SMMG leadership meetings.
• Along with the Credentialing Coordinator, ensures timely resolution of credentialing-related Epic work queues to facilitate revenue cycle functionality.
• Ensures confidentiality of data as required by legal and organizational standards.
• Performs other duties consistent with purpose of job as directed.

IV. Supervisory Responsibility: Direct line supervision of Credentialing Coordinator.Our Commitment to Diversity and InclusionTrinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity 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, status as a protected veteran, or any other status protected by law.00592836

Seniority level

• Seniority levelMid-Senior level

Employment type

• Employment typeFull-time

Job function

• Job functionHuman Resources
• IndustriesHospitals and Health Care

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