Authorization/Provider Credentialing Manager

Working Conditions and Physical Requirements

▪Frequently adjusts or moves items weighing up to 50lbs across office for various needs.

▪The ability to communicate information and ideas so others will understand. Must be able to exchange accurate information in these situations.

▪Constantly operates a computer and other office productivity machinery, such as a calculator, copy machine, computer, phone.

▪The person in this position needs to occasionally move about inside the office to access file cabinets, office machinery, etc.

▪Constantly remaining in a stationary position. Standing or Sitting for Prolonged Periods

▪Must be able to wear personal protective equipment, such as KN95 masks most of the day

▪Works Overtime and on Weekends as needed

▪Must have Sufficient Ambulatory ability to move to various locations.

Education and or Experience Requirements

▪High School Diploma or GED

▪Medical Assistant Certification (Preferred)

▪One Year or More of Demonstrated Skill in Similar Position (Preferred) Credentialing

Job Summary and Objectives

The Authorizations and Credentialling Manager will oversee the workflow of the Authorizations and Credentialing Department, related to eligibilities, authorizations and referrals for all medical services for RVAMG patients. The Authorization and Credentialing Manager will also oversee the processing of applications and reapplications for medical staff and RVAMG health professionals to ensure compliance with national accreditation standards and state and federal regulatory requirements. This position involves managing the verification of qualifications, certifications, and licenses of healthcare providers to ensure they meet the necessary standards for providing care. The Authorizations and Credentialing Manager will monitor all departmental processes, ensuring and tracking department’s efficiency and productivity. The Authorizations and Credentialing Manager will review and develop processes to maintain timeliness standards, follow clinical requirements and medical necessity for patient’s care.

Core Responsibilities

▪Develop and maintain Authorizations and Credentialing Department policies and procedures.

▪Maintain accurate information on accepted insurance plans.

▪ Maintain accurate and confidential credentialing databases and files, ensuring the security and integrity of sensitive providers’ information.

▪Communicate with insurance carriers, tracking updates and changes to prior authorization and medical necessity requirements.

▪Plan, assign, monitor, and appraise credentialing and authorizations staffs’ job results.

▪Manage time to maintain productivity, reorganize work activities when setbacks or priority changes are encountered.

▪Establish clear objectives and measurements, monitor staffs’ progress and results related to department goals and organizational initiatives.

▪Maintain, train, and evaluate staff on all processes and procedures in place.

▪Ensure that work completed by staff is timely, accurate and complete per policy and procedure, all authorizations are in place prior to patients’ appointments.

▪Assist Authorizations and Credentialing Department staff with resolving any issues to prevent backlog.

▪Assist and work with other departments’ management in implementing changes or additions to policies and procedures to improve day to day efficiencies.

▪Clearly articulate operation problems and positively contribute to solution development process.

▪Adhere to all patient care, departmental standards, policies, procedures, and meet regulatory requirements on a consistent basis.

Required Competencies

▪Excellent interpersonal and customer service skills

▪Excellent verbal and written communication skills

▪Understanding of frequently used Microsoft Office software such as Word, Outlook, and Excel

▪Knowledge of medical terminology

▪Advanced understanding of various insurance plans

▪Extensive experience with Insurance Eligibility and Authorizations

▪Knowledge of Medicare and Medicaid regulations and guidelines

▪Experience with practice management and EHR software

▪Experience with accurately interpreting payer contracts