Manager, Credentialing, South Bend, IN
Reports to the Director, Managed Care. Responsibilities include the centralization of all credentialing activities for Community Health Alliance (CHA), Beacon Medical Group, Beacon Health System, Beacon Health LLC, and any other Beacon Health System entity that employs providers. Implementing guidelines for PHO (Physician Hospital Organization) physician credentialing and re-credentialing as well as guidelines/standards of work/policies and processes for Beacon Managed Care Enrollment for all Beacon Entities. Manages the Credentialing Activities for CVO, Community Health Alliance and Beacon Managed Care Enrollment.
Education and Experience
The knowledge, skills and abilities as indicated below are normally acquired through the successful completion of a Bachelor’s degree in Business, Economics, Marketing or a related field. Three to five years of managed care and group insurance experience - - through which a background in Medicaid, Medicare and physician contracting was gained - - is preferred. Management/leadership experience is preferred.
Knowledge & Skills
- Demonstrates advanced knowledge of healthcare delivery systems (which includes PHO, HMO, PPO and POS).
- Demonstrates the management skills (including organization, planning, problem-solving, critical thinking, motivation, training and time management) necessary to direct a number of programs and supervise the activities of associates
- Requires knowledge of the regulatory environment affecting healthcare delivery systems and managed care.
- Demonstrates independent judgment, research and analytical skills necessary to develop programs, evaluate projects and approve (or recommend) changes in policies and procedures and the staffing levels that affect managed care credentialing and primary source verification
- Demonstrates the communication skills (both verbal and written) necessary to clearly articulate information to diverse individuals. Also requires the ability to give effective presentations before small and large groups.
- Demonstrates an advanced understanding of computer systems and proficiency in utilizing computer applications (i.e., word processing, spreadsheets and databases).
- Requires knowledge of the requirements of regulatory and accreditation organizations.
- Works in an office environment. Some travel is required.
- May need to vary days and hours scheduled, as determined by the department’s needs.
- Requires the physical ability and stamina to perform the essential functions of the position.