Credentialing Manager

Overview

Artificial Intelligence;
Advanced Technology;
The very best in patient care. With decades of expertise, Rad Net is Leading Radiology Forward. With dynamic cross-training and advancement opportunities in a team-focused environment, the core of Rad Net’s success is its people with the commitment to a better healthcare experience. When you join Rad Net as Indiana Credentialing Manager, you will be joining a dedicated team of professionals who deliver quality, value, and access in the 21st century and align all stakeholders—patients, providers, payors, and regulators—to achieve the best clinical outcomes.

• Responsible for ensuring providers are credentialed, appointed, and privileged with health plans, hospitals and patient care facilities.
• Ensure that the personnel/providers of a Rad Net facility, or Rad Net affiliated professional corporation (PC) are properly trained, licensed and certified as mandated by state and federal regulations. In addition, ensure that all services offered by these facilities and providers meet standards set by state and federal government agencies.
• Ensure continued high levels of performance with regulatory, accreditation, and internal requirements including but not limited to CAQH, NCQA, DOI, Medicaid, CMS.
• Provide leadership and oversight of the development, documentation and implementation of an Indiana accreditation plan, including auditing and coordination of multiple required program processes such as education and training.
• Lead, manage and ensure that all credentialing specialists review applications, verify both individual and facility accreditation, maintain records of verification and work with auditors as needed.
• Ensure the resolution of Claim Holds, Clearinghouse rejections and denials related to credentialing and provider enrollment issues in a timely manner to avoid delays and revenue loss.
• Maintain copies of all current licenses, DEA certificates, malpractice coverage and any other required documents for all providers.
• Maintain Verity and ECHO OAP databases in which new information or updates regarding employee training, licenses, education, continuing education and relevant job experience are captured.
• Ensure that all necessary licenses and credentials are verified and updated for the healthcare facility in which staff work, including background checks, licensing board contacts, license applications and references.

• At least seven years of experience in health care credentialing, insurance verification, appeals negotiations and processing in the health care industry, health care billing/claims processing, and data processing and software operations in the health care industry.
• Exceptions to years of experience may be made given extensive industry-related experience of at least 5 years in radiology credentialing and progressive team management.
• Requires a comprehensive understanding of Commercial health plans, Medicare and Medicaid health plans.
• Extensive knowledge of medical coding, CPT and HCPCS codes and ICD-10; direct radiology coding knowledge preferred.
• Comprehensive understanding of medical management and health insurance concepts, information management systems and strong analytical and problem-solving skills.
• Bachelor’s degree in healthcare administration highly preferred.
• Strong Excel data analysis skills and proficiency with Microsoft Office applications.
• Strong written, verbal and interpersonal communication skills.

• Communicates, cooperates, and consistently functions professionally with all levels of supervision, co-workers, patients, visitors, and vendors.
• Demonstrates initiative, personal awareness, professionalism and integrity, and exercises confidentiality in all areas of performance.
• Follows all local, state and federal laws concerning employment, including but not limited to I-9, Harassment, EEOC, Civil rights and ADA.
• Follows OSHA regulations, Rad Net and site protocols, policies and procedures.
• Follows HIPAA, compliance, privacy, safety and confidentiality standards at all times.