Credentialing Manager

Salary $80,000 - 110,000 depending on experience

Therapy Partners Group is the parent company of a thriving family of outpatient physical therapy and wellness brands throughout the United States. We are known for providing the highest quality individualized care for our patients and our team of highly skilled physical therapists?who?are passionate about helping patients achieve their goals.

The Credentialing Manager can be remote or sit at Home Office in Bolingbroook, IL.

Position Summary

The Credentialing Manager is responsible for overseeing all aspects of credentialing and recredentialing for all licensed healthcare providers of Therapy Partners Group. This role ensures all providers are appropriately credentialed and also includes maintenance of all systems that require appropriate credentialing information, i.e. billing applications, credentialing software and HRIS files. This is a key leadership position in compliance with licensing, billing and reimbursement.

Principal Accountabilities

• Conduct regular audits of the data entry components for new applications in the credentialing database.
• Manage the vendor (Prime Credentialing) of Credentialing Specialists to ensure deadlines are met, accuracy is carried out and priorities are set accordingly. Make recommendations if and when change may be necessary.
• Maintain the credentialing database and ensure up-to-date information is obtained at all times.
• Maintain working knowledge of State, Federal, contracting and payor regulations related to credentialing.
• Performs and collects primary source verification documentation for licensing, board certifications, proof of professional liability insurance, OIG, National Practitioner Data Bank (NPDB) and/or other sources as required based on national credentialing standards, health plan requirements and company credentialing policies.
• Responsible for monitoring and managing credentialing/re-credentialing requirements and to ensure the collection of all required renewal certifications are on file within the required time frame.
• Provide consistent and timely follow-up on all outstanding credentialing/re-credentialing files.
• Answer internal credentialing inquiries and provide support to therapists, management, office staff, health plan contacts and company departments as necessary.
• Process provider demographic changes ensuring appropriate documentation has been submitted with the changes, update credentialing database and notify health plans of changes.
• Process provider network terminations, specialty/category changes, leave of absence requests
• Participate in ongoing educational/training as required.
• Responsible for timely credentialing of denovo’s and acquisitions, both site credentialing and individual provider credentialing.
• Keep Raintree exceptions up to date. Make sure new providers have the appropriate exceptions within Raintree and take the exceptions off timely when payor credentialing is received.
• Work closely with RCM when credentialing holds can be released so TPG can submit the claims timely.
• Perform other related duties as assigned.
  
  

Knowledge, Skills and Abilities

• Must be able to work independently with experience in managing a outsourced vendor team of employees.
• Exceptional attention to detail with a keen awareness of the compliance and financial implications for poor quality of work, missed deadlines and / or a lapse of coverage.
• Ability to organize multiple priorities, plan, supervise and evaluate the work of others for the highest level of accuracy and timeliness. Embraces a culture of continuous improvement that promotes quality.
• Must be able to maintain confidentiality.
• Demonstrate accuracy, organizational problem solving and look for ways to continuously improve and promote quality of others.
• Must be able to stay focused in a fast-paced working environment with competing priorities and distractions.
• Demonstrate the ability to exercise exceptional good judgment and decision making within the scope of authority for this role.
• Must have the ability to speak with confidence and accuracy to providers, management, and stakeholders.
  
  

Management (Size and characteristics of the team(s): Manages all outsourced credentialing specialists.

Education And Experience

• Bachelors Degree in business functions highly preferred.
• Minimum of 3 years’ experience in a supervisory or management role in the credentialing or provider enrollment / contracting environment.
• Minimum of 6 years credentialing experience required.
• Strong background in claim operations as it relates to the accuracy of contracting and credentialing.
• Experience with health plans, credentialing applications, ability to interpret payor contracts and CAQH.
• Experience in Waystar and Raintree highly desired.
  
  

Physical Requirements and Working Conditions

Requires prolonged sitting, some bending, standing, stooping and stretching. Requires eye-hand coordination and manual dexterity enough to operate a keyboard, mouse, photocopier, telephone, calculator and other office equipment. Requires normal range of hearing and eyesight to record, prepare and present reports. Travel would likely not be required however long hours and weekend work may be required at times.

Therapy Partners Group is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind. This policy applies to all employment practices within our organization. Therapy Partners Group makes hiring decisions based solely on qualifications, merit, and business needs at the time.