Job Description

Job Description

Allied Digestive Health is one of the largest integrated networks of gastroenterology care centers in the nation with over 200 providers and 60 locations throughout New Jersey and New York. As a fast-growing physician-led organization, our dynamic structure encourages physician input and decision-making, while simultaneously offering operational support. Our dedicated, compassionate team of providers prioritize personalized treatment plans for patients that deliver the highest quality of care. All of our doctors are board-certified in gastroenterology and hepatology. Several of them serve as chief of gastroenterology at nearby hospitals, and a number of them have been recognized as top-quality physicians in publications, including but not limited to: Best Doctors in America and Top Doctors New Jersey, and US News Health - US News & World Report.

We are excited to announce that we are looking for a Full-Time, Credentialing Manager at our Corporate Office in West Long Branch, NJ.

*** This position does have the ability to be fully REMOTE/VIRTUAL, but may require up to 25% travel t o Corporate Office for meetings and site visits. ***

The Credentialing Manager responsibilities are:

• Assisting in managing the department's coordination and oversight of provider credentialing requirements across all medical practices and insurers.
• Manages credentialing vendor to the organizations needs as it relates to payer credentialing and makes sure they follow through on aligned expectations to facilitate credentialing requirements by monitoring progress and focus on improving gaps when it comes to time to credential providers.
• Develop plan to ultimately insource credentialing. Develop SOPs and policies needed to create the necessary structure for the department. Work with requisite leadership to implement required software to manage processes in-house.
• Communicate to all managed practices credentialing requirements to compel compliance.
• Oversee and manage all required reporting necessary to oversee progress in vendors system DOMO.
• In conjunction with RCM, provide information necessary for coordination and oversight of provider credentialing requirements across all managed practices and insurers. Leverage credentialing software, Medusa, to facilitate credentialing requirements to monitor and close gaps and reduce time to credential providers. Provider par Status (weekly).
• Assist, when needed with RCM to help close credentialing denials by troubleshooting
• Assist in reviewing and maintenance of managed care contractual agreements loaded in Athena to ensure accuracy between allowable, expected and paid amounts.
• Upkeep knowledge of payor policies and changes, communicating with the RCM department of those changes, and assisting in the education of the Management Services Organization (MSO).
• Assist in the education and onboarding of new and existing managed practices with credentialing.
• Act as an additional resource at the practice level and for credentialing by facilitating bilateral communication among onboarding stakeholders.
• Provides mentorship and guidance to the credentialing lead so that they can successfully perform their work and elevate in their role.

The Credentialing Manager must have the following qualifications and experience:

• High-school diploma or GED, Bachelor's degree preferred.
• AAPC or AHIMA credentialing/licensing preferred
• CPCS preferred
• 3-5 years' experience in credentialing, preferably in a healthcare setting
• Experience in managed care or revenue cycle management a plus
• Experience moving from outsourced to insourced credentialing a plus
• Proficiency with Microsoft office products including Word and Excel.

We offer a competitive base salary, generous benefits, including: Medical, Dental, Vision, Life Insurance, Voluntary, Time-Off Benefits, EAP, 401K and Commuter Benefits.

Job Type: Full-time

Job Tags

Full time, Remote job,

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