C&C Manager

Job Summary

The Contracting & Credentialing (C&C) Manager, under the supervision of the RCM Manger, working under the Director of Finance, is responsible for overseeing all provider and facility licensing, credentialing, and contracting across all applicable regions and health plans, including management of the C&C team members (Supervisor, Specialists, Coordinators). The C&C Manager will work cooperatively with many teams including Billing, HR, Recruiting, Providers, Operations, and the Owners, to ensure timely and accurate contracting and credentialing to meet staffing and facility needs in a rapidly growing organization.

Full-time

The Contracting & Credentialing (C&C) Manager, under the supervision of the RCM Manager, working under the Director of Finance, is responsible for overseeing all provider and facility licensing, credentialing, and contracting across all applicable regions and health plans, including management of the C&C team members (Supervisor, Specialists, Coordinators). The C&C Manager will work cooperatively with many teams including Billing, HR, Recruiting, Providers, Operations, and the Owners, to ensure timely and accurate contracting and credentialing to meet staffing and facility needs in a rapidly growing organization.

• Manage all essential functions performed by C&C team members, including Supervisor, Specialists, and Coordinators.
• Manage and lead day-to-day activities of staff who process credentialing and recredentialing applications for health care providers.
• Daily oversight and monitoring of employees’ workload and various credentialing workflows (i.e. onboarding, credentialing, EPCS and e-prescribe, provider and facility enrollments).
• Oversee all C&C tasks and duties and ensure each has a corresponding Standardized Operating Procedure (SOP).
• With guidance from the RCM Manager and Director of Finance, interview, hire, and provide a training plan for new staff on credentialing and recredentialing policies and procedures; also provide ongoing training and guidance as needed regarding new guidelines or updated processes and policies.
• Directly oversee C&C employees, their overall performance, and take action when performance issues arise and follow ups are needed, such as disciplinary coaching, performance documentation and/or termination.
• Implement department procedures to facilitate organized and up to date provider databases.
• Oversee periodic audits of credentialing files and staff deliverables.
• Oversee system for tracking license and certification expirations to ensure renewals are submitted in a timely manner.
• Manage team to ensure they monitor external credentialing databases including CAQH, PECOS, and other agencies to ensure data is updated and ready for quick retrieval.
• Manage application processes to ensure they are properly verified and accurately uploaded into an online credentialing database system.
• Manage and resolve complex questions regarding credentialing or provider database maintenance and best practices.
• Prepare and/or oversee reports on applications and credentialing statuses to identify trends and improve the credentialing process.
• Oversee and manage all provider and facility licensing, credentialing, and contracting necessary to ensure claims are paid and cash flow is not disrupted.
• Develop and oversee licensing, credentialing, and contracting workflows and processes as we scale our clinical team across California and potentially other states.
• Manage and oversee maintenance and accuracy of tracking databases of required provider and facility licenses, certifications, contract statuses, and credentials; in addition, review critical data and the associated documents on an ongoing basis to ensure compliance.
• Manage C&C team members to ensure AUC’s provider roster is current and accurate to mitigate risks associated with growth, drive efficiencies, and advance proactive monitoring and action related to licensing, credentialing, and contracting.
• Manage communication of provider and plan statuses, along with barriers related to operational processes, and drive solutions to overcome challenges.
• Ensure the C&C team…