Provider Enrollment Credentialing Manager (211928)

Job Description

The Provider Enrollment and Credentialing Manager (K0245484) Supervises operations and staff engaged in the review, audit, and validation of applications and/or provider data. Ensures required tasks are completed timely and accurately, with any issues or defects addressed promptly and tracked to resolution. Oversees the work of the vendor and ensures compliance to the agreed upon process.

Facilitates the management of provider enrollment, credentialing and provider information loading processes and inventory control. Works to ensure enrollment, credentialing, and revalidation processes ae efficient. Acts as a subject matter expert for these processes to communicate existing functionality and any needed changes to vendors and stakeholders. Participates in requirement and design discussions for system changes impacting providers.

Ensures all provider enrollment and credentialing policies and operations are following state and federal regulations. Performs analysis and oversight of these areas to validate compliance and proactively identify areas of improvement.

Job Responsibilities may include but are not limited to the following:

Generates reports from system for monitoring of work queue and aging inventory. Trends errors, identifies opportunities, and develops training programs. Works with internal departments to review, trend, and answer and document credentialing, enrollment, or revalidation issues, including system issues.

Regularly communicates with internal departments and external provider groups regarding provider enrollment and credentialing status and other provider related information. Strives to collaborate with external provider groups to maximize provider engagement and ensure the most up to date information in the system.

Develops, communicates, and enforces standard operating procedures for the department to ensure timely and accurate provider enrollment, credentialing and updating of provider demographic data and contract maintenance to ensure prompt and accurate payment to providers.

Communicates and monitors expectations and outcomes and evaluates individual and team performance. Supervises staff by providing coaching and guidance in specific areas related to overall job performance and accountability. Completes all expected supervisory duties, including training, performance management processes, timesheet approval, hiring duties, and coaching and feedback.

Minimum Qualifications:

• 2 years provider credentialing experience in a health plan, medical office, hospital, or similar administration
• Intermediate Microsoft Office (Word, Excel)
• Ability to interpret data into meaningful reports / documentation and communicate findings to others.
• Ability to lead a production-based team and manage file inventory and prioritize workloads.
• Ability to communicate with various internal and external contacts.
• Ability to multi-task

Education:

• High School, GED

Licensing & Certification:

• Valid Driver’s License – Incumbent is required to have and maintain a valid driver’s license when operating a state vehicle, a private vehicle, or a rental vehicle for the benefit of the State.

Preferred Qualifications:

Any additional skills, experiences, or qualifications that would be beneficial, but aren’t strictly necessary.

Preferred Qualifications:

• Bachelor’s Degree
• Word, Excel, PowerPoint, Access
• Proofreading, editing, attention to detail.
• Supervisory experience
• Provider enrollment experience
• Credentialing software experience
• Regulatory standards-NCQA, CMS, ODI
• Cross team collaboration
• Vendor oversight
• Communication skills
• Analytical skills
• Troubleshooting
• Managing priorities
• Manage operational processes.
• 2 years team lead or supervisory experience is preferred.
• Experience with provider enrollment is preferred.
• Knowledge of credentialing software.
• Knowledge of provider credentialing and/or database management procedures and regulatory standards such as NCQA, CMS, ODI and other regulatory bodies and the ability to apply to business operations.

About the Position:

• Who can apply: Anyone (External)
• Classified/Unclassified Service: Unclassified
• Full-Time/Part-Time: Full-Time
• Regular/Temporary: Regular
• Work Schedule: Monday-Friday, 8am-5pm (Flexible schedules available)
• Eligible to Receive Benefits: Yes
• Veterans’ Preference Eligible: Yes

Employment Benefits:

• Comprehensive medical, mental, dental, vision, and additional coverage
• Sick & Vacation leave
• Work-Life Balance programs: parental leave, military leave, jury leave, funeral leave
• Paid State Holidays (designated by the Governor annually)
• Fitness Centers in select locations
• Employee discounts with the STAR Program
• Retirement and deferred compensation programs

How to Apply:

Specific instructions for applying, which might include submitting a resume, cover letter, list of references, or completing an online application.

• Please include the Job ID number when emailing.

Job Application Process:  Only applications submitted within our State of Kansas Careers Portal will be considered.

• First Sign in or register as a New User at https://admin.ks.gov/offices/personnel-services/jobs
• Complete or update your contact information on the State of Kansas Careers Portal > My Contact Information page. *This information is included on all your job applications.
• Upload required documents listed for each specific job posting.
• Start your draft job application, upload other required documents, and submit when it is complete.

–  Manage your draft and submitted applications on the Careers> My Job Applications page.

• Check your email and My Job Notifications for written communications from the Recruiter.

–  Email – sent to the Preferred email on the My Contact Information page.

–  Notifications – view the Careers> My Job Notifications page.

Helpful Resources at jobs.ks.gov: “How to Apply for a Job – Instructions” and “How to Search for a Job – Instructions.”

Contact Information:

[email protected]

Salary Range

$ $75,000