Credentialing Manager

• Under general supervision of Revenue Cycle Manager, maintains, verifies, and tracks the expiration of certifications of facilities and individual providers throughout the organization. Reviews and completes all applications for facility credentialing and individual credentialing. Research to ensure up to date knowledge on medical policies, local licensing and certification requirements. Processes initial credentialing and re-credentialing applications.

Primary Duties and Responsibilities:

• Identify discrepancies in paneling/credentialing information given by facilities or individual providers and conduct follow-ups
• Sends all credentialing/paneling applications to the appropriate entity.
• Follows up bi-weekly with the appropriate entity for status updates on the completed application.
• Assists individual practitioners with credentialing inquiries.
• Capture primary source documentation in computer databases
• Ensure data is backed up
• Ensure that each facility within Mcintosh Trail Community Service Board has a valid credentialing license with the appropriate entities (including, but not limited to: Medicaid, Medicare)
• Ensure that each individual provider is paneled with the appropriate insurance entities according to the provider's licensure
• Request and keep track of all required documents for both individual providers and facilities
• Ensure that each individual provider's license is up to date
• Assist auditors in ensuring each provider has an up to date license that meets Georgia Law
• Keeps organized records of licenses for each individual provider
• Follow compliance laws, regulations, procedures, and policies.
• Assists individual providers in acquiring NPI numbers when appropriate

Competencies:

• Excellent verbal and written communication skills.
• Proficient with Microsoft Office Word and Excel.
• Proficient typing skills.
• Self-Motivated
• Ability to focus for extended periods.

Education/Work Experience:

Master's degree in mental healthcare field (including, but not limited to social work, counseling, mental health). One year experience in credentialing/paneling.