Credentialing Account Manager

The Credentialing Account Manager contributes to the ongoing achievement of the organization's goals through ensuring providers are credentialed using vetted processes and procedures. Identifies, analyzes, and resolves information discrepancies, and time gaps that could adversely affect a facility's ability to credential and/or privilege providers. Partners with medical staff, credentialing and privileging committees, and other key stakeholders to ensure compliance with credentialing standards. Responsible for maintaining accurate and comprehensive data in the credentialing software.

The Account Manager must have overall knowledge of the credentialing and privileging process, know the required credentials for health care professionals and utilize the appropriate resources to complete Primary Source Verification (PSV) and all others requested. Account Managers demonstrate a thorough knowledge on credentialing policies, guidelines, and regulations for the CVO credentialing process.

• Assists Manager in all credentialing aspects of regulatory reviews including, but not limited to, State and Federal regulations, NCQA, CMS, and TJC, URAC. Prepares or reviews all pre-audit documents to assure accuracy
• Participates in the staff interview process and assures that all recommendations are implemented to assure continued compliance
• Responsible for fostering effective relationships and communications with operational leadership, physicians, revenue cycle, payers, hospital leaders, and hospital partners
• Processing of provider applications and re-applications
• Maintains accurate provider profiling system data
• Communicate with client representatives
• Assists Manager with staff meetings to discuss file progress and any potential delays
• Responds to requests for provider information • Enforces regulatory compliance and quality assurance
• Support, in conjunction with the QA Team, any adverse action activities in accordance with regulations and policies
• Prepare documentation, conduct, and conclude credentialing and privileging meetings with various clients as described contractually
• Work, in conjunction with leadership, to identify potential 'pitfalls' in the CVO credentialing process
• Meet productivity standards as outlined in CVO and client metrics

• Strong knowledge of industry standards, to include but not limited to: CMS, TJC, NCQA, AAAHC and DNV
• Strong knowledge of the Microsoft office suite to include Excel
• Affinity to multi-tasking
• Strong interpersonal skills-works well with a team
• Strong oral and written communication skills
• Strong conflict resolution skills
• Exceptional attention to detail
• Exceptional analytical skills
• Customer interaction experience

Qualifications Required:

• Bachelor's Degree and/or equivalent work experience
• At least 3+ years of experience in medical credentialing