Credentialing Manager (Remote anywhere in the US)

Full time
Posted 3 months ago

The Role

Tollanis Solutions is a Managed IT Service provider that provides the technological tools, expertise, and solutions needed for an organization to thrive. Working with our partner Credentially, Tollanis is committed to transforming the way healthcare organizations carry out recruitment by providing them with an innovative IT solution that will streamline hiring, onboarding, and compliance for greater efficiency and ROI.

The Credentialing Manager, oversees the operations of the Tollanis Centralized Verification Office (TCVO) to develop, manage and monitor processes and procedures that support the credentialing, re-credentialing, expirables data management, and delegated credentialing contract processes related to physician, nurse and other employee verifications. Oversees all of the credentialing functions including application management and primary source verification. Ensures compliance with the appropriate accrediting and regulatory agencies. Supervises Credentialing Specialists in the day-to-day management of the overall TCVO credentialing process and database management. 

Responsibilities: 

  • Manages the TCVO credentialing process for all clients, in accordance with, TJC, DNV, AAAHC NCQA, URAC, and CMS accreditation standards, Federal and State laws.
  • Coordinates the management of the credentialing database and associated modules, ensuring accuracy of data and reporting to downstream systems. Monitors critical data for extensive analysis and report generation.
  • Coordinates the management of the electronic credentials application, to ensure distribution, receipt, processing, and timely delivery to clients.
  • Coordinates the management of the expirables process to ensure all clinical provider licenses and certificates remain current, ensuring appropriate notification prior to expiration.
  • Monitors and reports turnaround times for processing of credentials applications, with continued focus on delivery of a high quality product, with the greatest efficiency, in the least amount of time,
  • Ensures compliance with accrediting organization requirements; participates in development and review of TCVO Operating policies and procedures, develops, recommends, and/or implements changes, revisions, and enhancements as appropriate to current operating environment.
  • Provides consultations with clients with regards to credentialing practices and services; prepares and conducts credentialing client reviews.
  • Analyzes TJC, DNV, AAAHC, NCQA, URAC, and CMS standards and develops criteria to ensure compliance; revises general aspects of credentialing and privileging process as necessary; makes recommendations for and implements changes in policies and procedures.
  • Prepares for and coordinates credentialing audits in compliance with the credentialing contracts.
  • Functions as primary TCVO credentials contact for all clients; develops and maintains positive working relationships.
  • Oversees the supervision of personnel, which includes work allocation, training, promotion, enforcement of internal procedures and controls, and problem resolution; evaluates performance and makes recommendations for personnel actions; motivates employees to achieve peak productivity and performance.
  • Represents the TCVO to internal and external customers as appropriate; makes presentations to and interacts with various internal and external customers on issues pertinent to area of specialty.
  • Performs miscellaneous job-related duties as assigned.

Required Skills and Professional Expertise:

  • Ability to make administrative/procedural decisions and judgments.
  • Ability to investigate and analyze information and draw conclusions.
  • Ability to develop and deliver presentations.
  • Ability to process computer data and to format and generate reports.
  • Ability to supervise and train employees, to include organizing, prioritizing, and scheduling work assignments.
  • Ability to communicate effectively, both orally and in writing.
  • Ability to foster a cooperative work environment.
  • Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.
  • Skill in developing policy and procedure documentation.
  • Database management skills.
  • Employee development and performance management skills.
  • Knowledge of related accreditation and certification requirements.
  • Knowledge of medical credentialing and privileging procedures and standards.
  • Knowledge of medical staff policies, regulations, and bylaws and the legal environment within which they operate.
  • Knowledge of leading a remote team.

Qualifications:

  • Minimum of  7 years of experience directly related to the duties and responsibilities specified. 
    • Completed degree(s) from an accredited institution or 10+ years of experience 
  • NAMSS Certification/Licensure as a Certified Professional Medical Services Manager (CPMSM) a plus

What We Offer

  • Work from Home – we are a remote first organization 
  • Ability to advance in a fast growing IT startup 
  • Competitive salary in USD commensurate with experience 

Individuals seeking employment at Tollanis Solutions are considered without regards to race, color, religion, national origin, age, sex, marital status, ancestry, physical or mental disability, veteran status, gender identity, or sexual orientation.

Job Features

Work From Home (WFH)

Must be in the US

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