Posted in Other 30+ days ago.
Location: Hartford, Connecticut
Job Title
Credentialing Operations Lead
Status
Full Time
Education and Experience
Associates degree required
Bachelor's degree preferred
SUMMARY
Provides support for payer/managed care, Medicare and Medicaid Enrollment operations by organizing the functions relating to the credentialing process for all applicable practitioners as identified. This position is responsible for monitoring Credentialing delegated activities while adhering to Connecticut Children's Medical Center, federal and state regulatory/accreditation requirements and standards. Coordinates, conducts, and documents delegation and site visit assessments as necessary to comply with state, federal, NCQA and any other applicable requirements. Requires a fundamental understanding of the insurance credentialing process and terminology related to the job. REMOTING OPTION IS AVAILABLE
ROLE RESPONSIBILITIES
SUPERVISORY RESPONSIBILITIES
Supervision of Credentialing Specialists and Medical Staff Coordinators
KNOWLEDGE, SKILLS AND ABILITIES REQUIRED
KNOWLEDGE OF:
Knowledge of regulatory/accreditation requirements and standards (TJC, CMS, DOH, HIPAA, NCQA).
Understanding of program and provider enrollment and credentialing regulations and requirements preferred.
SKILLS:
Detailed-oriented and analytical maintain accuracy in a documented process
Must have excellent verbal/written interpersonal/communication skills and experience at all levels.
Computer knowledge of credentialing database software.
PC proficiency, proficiency in Microsoft Office applications and ability to effectively utilize other software and systems as needed.
ABILITIES:
Ability to establish and maintain positive relationships, building trust and respect by consistently meeting and exceeding expectations
Work Environment:
Office setting, fast paced work environment however great attention to detail. REMOTING OPTION IS AVAILABLE
Physical Requirements:
Amount of Time (Choose which ones do apply) |
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< 25% day |
Occasional 25-50% day |
Frequent 50-75% day |
Constant > 75% day |
Stand |
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Walk |
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Sit |
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Manual Dexterity/Repetitive use of hands, wrists, arms, elbows |
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Forward reach w/hands and/or arms |
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Climb or balance |
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Stoop, kneel, crouch |
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Overhead/above shoulder reaching |
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Choose Applicable Lifting Demands |
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LIFT |
Floor-Waist |
Waist-Shoulder |
Above Shoulder |
< 15 lbs. |
Occasionally |
Occasionally |
Occasionally |
15 - 25 lbs. |
Not Applicable |
Not Applicable |
Not Applicable |
25 - 40 lbs. |
Not Applicable |
Not Applicable |
Not Applicable |
50 lbs. |
Not Applicable |
Not Applicable |
Not Applicable |
PUSH/PULL |
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< 50 lbs. |
Not Applicable |
50 - 100 lbs. (push/pull only) |
Not Applicable |
JF White
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CohnReznick
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CohnReznick
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