Quality Assurance and Compliance
North Baltimore, MD
The Credentialing Manager is responsible for overseeing all aspects of the credentialing, re-credentialing, and privileging processes for all medical providers who provide patient care.This position directly supervises all credentialing specialist staff.
Successful candidates will possess the following:
Associates Degree or four (4) year Bachelor’s Degree preferred.
Certified Provider Credentialing Specialist preferred.
At least three (3) years of supervisory or management level experience in managed care, medical staff services, health services or healthcare credentialing programs; or an equivalent combination of education and experience which would provide the required knowledge, skills, and abilities.
At least five (5) years of experience in healthcare credentialing, medical billing follow-up, patient registration, charge entry, billing, and medical policies.
Advanced knowledge of applicable credentialing and licensing requirements for physicians, mid-levels and the Ambulatory Surgical Centers (ASC).
Advanced knowledge of applicable state board of licensing applications for medical providers.
Advanced knowledge of Medicare credentialing procedures and protocols for medical providers and ASC.
Advanced knowledge of Medicare, Medicaid, BC/BS, Workers Compensation, Manage Care, and Commercial insurance carriers billing regulations.
Ability to review and interpret patient bills, vouchers, error lists and reports to identify incorrect data and make appropriate revisions.
*Send resume to firstname.lastname@example.org