Staff Readiness Manager
$85k - $100kNR Consulting
Title Staff Readiness Manager
Full Time
Location: Albuquerque, NM 87109
Salary : $85,000.00 - $100,000.00 per year + Benefits
Schedule : Monday to Friday Job Description
Job Responsibilities:
Full Time
Location: Albuquerque, NM 87109
Salary : $85,000.00 - $100,000.00 per year + Benefits
Schedule : Monday to Friday Job Description
- The Staff Readiness Manager will oversee the daily operations of primary source and credentials verification service, provider enrollment / insurance credentialing, background investigations, and fingerprint services department in accordance with JCAHO and NCQA standards, and other applicable state and federal laws, regulations and standards.
- Oversee file processing activity including organization, prioritization, follow-up, and customer support. Identify opportunities for internal improvement and expansion of the customer base.
- Ensure departmental activities adhere to internal policies and procedures, meet customer expectations, and are in compliance with regulatory standards.
- Working knowledge of the health care deliver and insurance industry. Must have a working knowledge of accreditation and certification standards for JCAHO and NCQA, and applicable federal and state laws as they apply to the credentialing procedures for hospitals and health plans.
Job Responsibilities:
- Develops and manages the processes for the screening and verification of credentials documents for initial appointment and reappointment to the various medical staffs and managed care organizations.
- Acts as a resource for customers regarding accreditation standards and credentialing processes.
- Oversees the performance of credential file audits for customer organizations based on applicable JCAHO, NCQA and other standards. Performs all verification activities at a senior level to assist the credentials analysts with meeting quality standards and timelines.
• Develops and manages the process related to the insurance carrier Provider Enrollment / Insurance Credentialing program. - Acts as a resource for customers and staff assisting with the ongoing customer management, support and program development.
- Prepares the annual operating and capital budgets for the Staff Readiness Services programs including credentials verification, provider enrollment, background investigations and fingerprint services, and monitors ongoing budget compliance to ensure that the company achieves financial success.
- Develops and administers the quality assurance programs for the credentials verification program, and ensures that all activities are compliant with JCAHO and NCQA standards.
- Assists with the development and implementation of the plan for ensuring continued certification by NCQA biannually.
- Oversees the background investigations and fingerprinting programs and ensures that all operations are performed in a timely and accurate manner in accordance with applicable statutes and regulations including the coordination and preparation for the annual Social Security Administration audit and file review.
- Assists with the development and implementation of the marketing and sales plans for the programs and services, and participates in the development of the marketing strategy and plan for the organization.
- Completes monthly billing, performance reporting, scheduling, and planning, workload analysis and work assignments.
- Maintains various reports for distribution to appropriate internal and external customers. Such reports include, but are not limited to, monthly billing reports, updated provider reports, file maintenance reports, licensure expiration reports, and credentialing status reports.
- Participates in strategy development with the management team, and establishes and monitors program goals and objectives for the department in order to contribute to the successful achievement of the company's goals and objectives.
- Assists with the operational aspects of software development projects to include input on functionality, processes, implementation, testing, and rollout to staff and customers.
- Provides supervision and specific direction to direct reports. Ensures that all staff members are in compliance with established performance criteria and standards through the Weekly Operating Report and follow-up, as required. Develops and maintains the procedural manuals for the department.
- Actively supports and participates in companywide performance excellence programs and initiatives.
- Identifies and supports sales opportunities and performs ongoing customer relations activities to promote program awareness and customer satisfaction.
- Assists with special projects as assigned under the direction of the President.
- Insurance Credentialing: 5 years (Preferred)
- Management: 5 years (Preferred)
- NCQA standards: 5 years (Preferred)
- Provider Relations: 3 years (Preferred)
Vacancy posted 3 days ago
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