Credentialing Manager

Location: Garner, North Carolina US

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Job Number: 3232

Position Title: Credentialing Manager

External Description:

Pivot Health Solutions, the parent company of Pivot Physical Therapy, Pivot Occupational Health, Pivot Sports Medicine and Pivot Performance, has an immediate opening for an energetic and results-driven Credentialing Manager. If your passion is process improvements, streamlining workflows and leading a team for a growing company dedicated to patient care, health and wellness, apply now! 

Job Summary:

Pivot Health Solutions is looking for a self-motivated, detail oriented and forward thinking Credentialing Manager that is CPCS certified (Certified Provider Credentialing Specialist) and has NCQA experience. The Credentialing Manager will oversee internal and external credentialing process under the supervision of the Senior Vice President of Revenue Cycle. Responsible for training and supervising the credentialing team. The Credentialing Manager will audit credentialing files to NCQA standards as well as interact with Insurance Carrier Contacts, Senior Management, Revenue Cycle, and others departments as necessary to facilitate the credentialing and enrollment processes timely and efficiently.

Reports to: Senior VP of Revenue Cycle Management

Essential Functions:

  • Responsible for managing all aspects of therapist credentialing both internally and externally
  • Manage day to day Credentialing Team including training all new hires
  • Ensure clinician credentials are up to date, administer tracking, and reminder system
  • Supervise completion of OIG and SAM checks monthly and SOR checks for all clinical employees biannually
  • Ability to work independently with limited supervision and meet deadlines
  • Ability to work effectively with staff, clinicians and external customers
  • Complete clinician applications for the state medical licenses; work closely with the state licensing boards
  • Populate and prepare applications for providers
  • Facilitate and Track onboarding paperwork and applications to and from providers
  • Review provider applications for accuracy and completeness
  • Maintain complete and accurate provider credentialing files
  • Monitor and notify providers of upcoming expiable certifications, licensures, board certifications, and all other state and national required documents necessary for the practitioner to legally and ethically perform under their scope of practice
  • Maintain and update the credentialing database and medical staff services as provider information and credentials change or renew
  • Provide weekly status updates to providers and leadership
  • Demonstrate exemplary customer service to our providers and facilities
  • Filing, data entry, database maintenance and other duties as assigned

 

 

 

 

Knowledge, Skills & Abilities:

Education:

  • Team manager with over 5 years’ experience preferred
  • Associate's degree or equivalent and two years’ work related experience, Bachelor's degree preferred
  • CPCS (Certified Provider Credentialing Specialist)

Experience:        

  • EchoOne App experience preferred
  • Prior credentialing experience

Skills & Abilities

  • Good communication skills – written, telephone, and email. Must be articulate, personable, and able to make calls to clinic staff offices
  • Attention to detail, good computer skills – MS, Word, Excel
  • Must have high level of interpersonal skills to handle sensitive and confidential situations
  • Have strong organizational and time management skills
  • Knowledge of organization's policies, procedures and systems
  • Ability to work effectively in a fast paced, high volume environment
  • Demonstrate ethical problem-solving skills

Address1: 350 New Fidelity Court

Company: Pivot Physical Therapy

PostalCode: 27529

City: Garner

State: North Carolina

Community / Marketing Title: Credentialing Manager

Company Profile:

Pivot Health Solutions is a premier provider of health and wellness services that focus on getting people back to health, preventing injury and staying fit where they work, live and play.  Our core offerings include: Pivot Physical Therapy— helping people get back on the move by delivering the highest quality care and superior functional outcomes through evidence-based practice; Pivot Occupational Health— helping businesses keep workers healthy and safe, while controlling employee health care costs; Pivot Sports Medicine— helping athletes of all ages meet their performance needs with personalized services to safely prevent or recover from sports-related injuries; and Pivot Performance— helping athletes at all levels reach peak performance with customized, instructor-led programs for individuals, semi-private groups and athletic teams. No matter where a person is on the spectrum of health, we have a personalized solution delivered by the best professionals in their chosen fields.

 

EEO Employer Verbiage:

Pivot Health Solutions provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Pivot Health Solutions complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Pivot Health Solutions expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of Pivot Health Solution's employees to perform their job duties may result in discipline up to and including discharge.

Location_formattedLocationLong: Garner, North Carolina US

Pivot Health Solutions is an Equal Opportunity Employer. © 2018 All Rights Reserved.