Job Details

Manager - Credentialing Audit & Oversight

Department: Ops - Credentialing

Employment Type: Full Time

Location: 1600 Corporate Center Dr., Monterey Park, CA 91754

Reporting To: Director - Credentialing

Compensation: $90,000 - $120,000 / year

Description

The Credentialing Audit and Oversight Manager is responsible for managing the initial credentialing, re-credentialing and the continuous credentialing processes for individual and organizational Providers; supervision of credentialing staff, maintenance of the integrity of Provider data and contracts in credentialing files, and in the credentialing database, compliance with regulatory and accreditation standards.

Our Values

• Put Patients First
• Empower Entrepreneurial Provider and Care Teams
• Operate with Integrity & Excellence
• Be Innovative
• Work As One Team

What You'll Do

• Facilitate regulatory audits, cooperating with credentialing Contract plans' delegation oversight audits, and conducting internal audits.
• Responsible for performance expectations related to compliance and credentialing quality control, delegation oversight of credentialing vendors, and departmental goals.
• Collaborate with fellow leadership, co-workers, network providers, and staff in other departments to achieve departmental and organizational objectives and to deliver exceptional Provider Services.
• Foster an environment of continuous learning, staff development, and performance improvement through defined metrics.

Qualifications

• Bachelor's degree in Health Care Administration or Business-related discipline or 4 years of related experience.
• NAMSS Certification (CPCS or CPMSM) strongly preferred or eligibility to acquire within 12 months after date of hire as needed.
• Four years of experience in the following areas: Hospital Credentialing, Health Plan Credentialing.
• Two years of management experience in auditing and managing a credentialing department.
• Two years of active collaboration experience with auditors.
• Strong attention to detail, critical thinking, problem solving and analytical skills.
• Demonstrated ability to work collaboratively, multi-task and meet deadlines in a complex, rapidly evolving environment with staff across the organization/departments.
• Proficiency in MS Office suite.
• Strong interpersonal, communication, organizational and time/project management skills are essential.
• Excellent written and verbal communication skills.

Environmental Job Requirements and Working Conditions

• This is a hybrid position. The home office is located at 1600 Corporate Center Dr., Monterey Park, CA 91754.
• The total compensation target pay range for this role is $90,000 - $120,000. The salary range represents our national target range for this role.