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Credentialing Manager


Posted: 10/2/2019
Job Reference #: 5000492752806
Keywords: operations

Job Description

Employment Type


Exempt or Non-Exempt


Job Summary

Plan, organize and direct all operations of HMSA's credentialing, recredentialing and credentialing appeal processes for all categories of practitioners and providers in support of credentialing strategy and initiatives for all lines of business

Minimum Qualifications

  1. Bachelor's degree and five years of related work experience; or equivalent combination of education and related work experience.
  2. Two years of previous supervisory experience.
  3. Good working knowledge of Microsoft Office applications
  4. Effective verbal and written communication skills.
  5. Strong interpersonal skills.
  6. Strong project management skills.
  7. Occasional travel between different work locations during work hours or report to alternate work locations to conduct and accomplish business related activities.

Duties and Responsibilities

  1. Manage operations for the credentialing and recredentialing process to satisfactorily meet all standards as required by HMSA policies and procedures, state and federal regulatory requirements and all relevant accreditation standards pertaining to the credentialing for HMSA providers in all lines of business including commercial, Medicare, Medicaid and ACA products.
  2. Develop and mentor staff by providing direction on projects and tasks, and managing performance, career development, compensation, recruitment and training.
  3. Monitor performance reports and make operational adjustments as necessary to maintain applicable service and quality levels.
  4. Manage relationships for delegated credentialing entities to ensure compliance with applicable contractual, state and federal requirements, and accreditation standards.
  5. Work collaboratively with other internal HMSA departments such as Provider Services, Legal Affairs, Provider Data Administration, etc. to ensure effective integration and communication regarding credentialing matters.
  6. Prepare annual credentialing unit plan and budget, monitor regularly, and take appropriate action to manage actual expenses again budgeted expenses.
  7. Perform other duties as assigned.