Credentialing Manager

Job Description

Job Description

The Credentialing Manager plays a critical role in bridging communication between claims and credentialing departments to ensure seamless provider support and claims processing. Responsible for managing provider relationships, resolving credentialing and claims issues, and supporting the integrity of provider data, this position contributes significantly to operational success. The manager also provides training to providers on billing procedures and supports members and providers in navigating referral processes, all while maintaining excellent customer service standards within a small team environment. Occasional local travel and proficiency with claims processing and CRM tools are part of this role.

 

Responsibilities

• Act as liaison between claims and credentialing departments
• Field, resolve, and escalate provider issues including claims inquiries and credentialing updates
• Support Provider Relations by managing high volumes of calls, emails, and documentation
• Review paper and electronic claims for Medicaid/Long-Term Care services
• Communicate with network providers to request documentation and update databases
• Collaborate with credentialing and claims teams to complete projects
• Establish and maintain relationships with existing and new network providers
• Provide provider training on billing via the Provider Claims Portal
• Assist providers with claims issues through multiple communication channels
• Help members and providers navigate referral processes and understand benefits
• Execute contracts and single case agreements as required
• Maintain confidentiality of claims and provider information
• Perform data entry, filing, and mailing tasks

 

Required Qualifications

• Bachelor’s Degree in Healthcare Management or related field
• Minimum of 2 years experience in a similar credentialing or claims support role
• Knowledge of credentialing processes and claims management
• Advanced customer service and interpersonal skills
• Proficient communication, organizational, and analytical abilities
• Reliable transportation for occasional local travel
• Bilingual proficiency in English and Spanish

 

Company Description

Join Little Havana Activities and Nutrition Centers of Dade County, Inc. (LHANC)

Little Havana Activities and Nutrition Centers of Dade County, Inc. (LHANC) is a tax-exempt, charitable non-profit organization dedicated to serving socially isolated and economically disadvantaged seniors throughout South Florida.

At LHANC, we are driven by a strong commitment to service, integrity, and compassion. Our mission is to provide a wide range of social, nutritional, and health-related services that support low-income, frail, and isolated older adults. Through targeted funding and community partnerships, we help seniors maintain their independence, continue living safely at home, and avoid premature and costly institutionalization.

Our programs are designed to meet the growing needs of the elderly population and are delivered with dignity, respect, and sensitivity. LHANC is funded through government grants and private donations and is a licensed TPA vendor for Sunshine Health.

Company Description

Join Little Havana Activities and Nutrition Centers of Dade County, Inc. (LHANC)\r\n\r\nLittle Havana Activities and Nutrition Centers of Dade County, Inc. (LHANC) is a tax-exempt, charitable non-profit organization dedicated to serving socially isolated and economically disadvantaged seniors throughout South Florida.\r\n\r\nAt LHANC, we are driven by a strong commitment to service, integrity, and compassion. Our mission is to provide a wide range of social, nutritional, and health-related services that support low-income, frail, and isolated older adults. Through targeted funding and community partnerships, we help seniors maintain their independence, continue living safely at home, and avoid premature and costly institutionalization.\r\n\r\nOur programs are designed to meet the growing needs of the elderly population and are delivered with dignity, respect, and sensitivity. LHANC is funded through government grants and private donations and is a licensed TPA vendor for Sunshine Health.