Manager - Credentialing and Enrollment

HarmonyCares hiring for Manager - Credentialing and Enrollment jobs in Bloomfield Hills, MI, US

Overview

HarmonyCares is one of the nation’s largest home-based primary care practices. HarmonyCares is a family of companies all dedicated to providing high-quality, coordinated health care in the home. This includes HarmonyCares, HarmonyCares Medical Group, HarmonyCares Home Health and HarmonyCares Hospice.

Our Mission – To bring personalized, quality-based healthcare to the home of patients who have difficult accessing care.

Our Shared Vision – Every patient deserves access to quality healthcare.

Our Values – The way we care is our legacy. Every interaction counts. Go the extra mile. Empower and support each other.

Why You Should Want to Work with Us

• Health, Dental, Vision, Disability & Life Insurance, and much more
• 401K Retirement Plan (with company match)
• Tuition, Professional License and Certification Reimbursement
• Paid Time Off, Holidays and Volunteer Time
• Paid Orientation and Training
• Great Place to Work Certified
• Established in 11 states
• Largest home-based primary care practice in the US for over 28 years, making a huge impact in healthcare today!

Responsibilities

Under the direction of the Director, the Manager - Credentialing and Enrollment directs and coordinates all functions of the credentialing and enrollment department to ensure accurate, timely and compliant credentialing and provider enrollment. This role requires strong managerial, leadership, business office skills, and critical thinking to lead the provider credentialing and enrollment department and directly manage day-to-day operations.

Essential Duties and Responsibilities

• Responsible for driving HarmonyCares culture through values and customer service standards
• Accountable for outstanding customer service to all external and internal customers
• Develop and maintain effective relationships through effective and timely communication
• Ensure credentialing files are complete and reviewed for presentation to our Credentialing Committee
• Responsible for compliance with Federal and multi-state regulations in addition NCQA and CMS regulations
• Maintain credentialing and verification protocol of perspective providers and enhance process flow when applicable
• Lead the team to ensure they meet or exceed credentialing standards
• Responsible for the accuracy and integrity of the credentialing database and for ensuring the timeliness of credentialing / re-credentialing verifications
• Serve as one of HarmonyCares’ provider credentialing and enrollment subject matter experts
• Work directly and in strong collaboration with all internal and external customers, inside and outside of credentialing
• Analyze provider rosters for accuracy and completeness and follow up on any issues
• Perform miscellaneous job-related duties as assigned

Qualifications

Required Knowledge, Skills, and Experience 

• High school diploma or equivalent
• At least 5 years of experience in credentialing for any of the following entities, Hospital medical staff office, managed care credentialing department, or physician group practice credentialing department
• At least 3 years of experience in multi-state provider and group enrollment
• At least 3 years of experience in a leadership role directly overseeing team members
• Expert knowledge of NCQA and CMS requirements as they relate to medical staff credentialing and privileging
• Extensive experience with NPI, taxonomy and NPPES
• Extensive knowledge of database management and credentialing software
• Seasoned in developing, implementing, and administering work processes
• Ability to partner with shared stakeholders to achieve mutual success
• Proficient in Microsoft Office, including Outlook, Word, and Excel
• Skill in examining and re-engineering operations and procedures, formulating policy, and developing and implementing new strategies and procedures
• Ability to prioritize and multi-task in a fast-paced environment
• Ability to foster a collaborative work environment
• Proficient with employee development and performance management skills
• Ability to motivate team and create a culture of accountability at all levels
• Interpersonal skills sufficient to effectively communicate both written and orally with department teams, practitioners, medical staff office, administrative and medical staff leaders

Preferred Knowledge, Skills, and Experience 

• Bachelor’s degree or higher in health care administration or related field
  
• Certified Professional Medical Service Management Certification (CPMSM) or Certified Provider Credentialing Specialist Certification (CPCS)
  
• Experience working directly with vendors
• Experience in IntelliCred, sPayer, and Centricity software
  

Pay Transparency

Individual compensation packages are based on various factors unique to each candidate, including skill set, experience, qualifications, and other job-related considerations.
Notice

HarmonyCares and HarmonyCares Hospice are not affiliated with Harmony Hospice Care. HarmonyCares Hospice does not conduct business in OH. HarmonyCares Hospice conducts business in MI, VA, WI, TX, IN, IL.