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in Miami, FL
Credentialing Manager
Hours | Full-time, Part-time |
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Location | Miami, Florida |
About this job
Job Description
Key Responsibilities:
- Manages the Provider Credentialing functions for the plan
- Supervises and trains the Credentialing Staff
- Creates and revises credentialing policies, procedures and workflows, to ensure compliance with all regulatory and contractual credentialing requirements
- Conducts oversight of the delegated credentialing process for appropriate subcontractors
- Organizes and oversees the Credentialing Committee process
- Maintains continuous monitoring databases for NPDB, Medicare Opt-out and Licensure
- Familiarity with Credentialing and Re-credentialing variety of physician specialties, allied health providers and ancillaries
- Performs other duties as assigned
- Bachelor’s degree in Health Administration or related field, preferred
- Minimum of three (3) years of supervisory or management level experience in managed care, medical staff services, health services or government assistance programs; or an equivalent combination of education and experience which would provide the required knowledge, skills and abilities to perform the job duties.
- Current Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Staff Management (CPMSM) with the National Association of Medical Staff Services is preferred
- Familiarity with NCQA and AAAHC accreditation standards
- Good verbal communication skills (Fluent in Spanish - preferred but not required)
- Excellent organizational skills
- Extremely detail-oriented
- Knowledge of basic medical terminology.
- Ability to analyze data and make appropriate decisions.
- Ability to work as a team under stressful conditions.
- Good verbal communication skills (Fluent in Spanish - preferred but not required)
- Excellent organizational skills.
- Extremely detail-oriented.
- Ability to maintain confidentiality.
- PC proficiency and Windows®-based software knowledge (Microsoft Word, Excel, Outlook) required.
Note: This description indicates, in general terms, the type and level of work performed and responsibilities held by the team member(s). Duties described are not to be interpreted as being all-inclusive or specific to any individual team member.
No Third Party Agencies or Submissions Will Be Accepted.
Our company is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. DFWP
Opportunities posted here do not create any implied or express employment contract between you and our company / our clients and can be changed at our discretion and / or the discretion of our clients. Any and all information may change without notice. We reserve the right to solely determine applicant suitability. By your submission you agree to all terms herein.
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