Provider Credentialing Manager, Gateway Learning Group, Concord, CA

Posted on March 28th, 2017

Gateway Learning Group, a San Francisco-based fast growing business in the education/health sector, is seeking a full-time experienced provider credentialing manager.

Responsibilities 

• Lead company’s provider credentialing process, overseeing day-to-day tasks of two staff members for credentialing and re-credentialing new and current employee providers of ABA (Applied Behavioral Analysis) therapy to children on the Autism spectrum.
• Interprets healthcare insurance company requirements and disseminates information to all involved parties, internally and externally to assure necessary compliance, compatibility and continuous quality improvement of credentialing processes.
• Monitors company’s BCBA’s (Board Certified Behavioral Analysts) and RBT’s (Registered Behavioral Techs) for credentialing and recredentialing compliance and submission to various Health System entities, e.g. insurance companies, Medicare and Medi-Cal.
• Ensure the accuracy and integrity of the credentialing database system and related applications, and the seamless, timely flow of credentialing information to meet verification and re-credentialing deadlines of Health Insurance Payers.
• Interpret basic health insurance company and related contracts, ensuring compliance with appropriate healthcare insurance company credentialing guidelines.
• Conduct audits and provide solutions to reduce errors and improve processes, compiling credentialing statistics for internal tracking and reporting.
• Inform Gateway President and Revenue Cycle leadership of key issues, acts as agent in influencing changes in Program quality and agency requirements.
• Develop and implement streamlined processes that meet requirements and adhere to Credentialing Policies and Procedures.
• Creates credentialing communications to support company business objectives.
• Coach, train credentialing staff, and collaborate with other department staff.
• Performs miscellaneous job-related duties as assigned.

Qualifications

Experience

• Minimum 1–3 years experience in a healthcare credentialing lead or supervisory position.

Education

• Associate's degree in health care administration, public health, or related field required, OR 3 years of work experience in a directly related field required. * High School Diploma or General Education Development (GED) required.
• Certified Provider Credentialing Specialist (CPCS) certificate (or pursuing one) a plus.

Additional Requirements

• Strong knowledge of the credentialing process and accreditation and regulatory standards. Ability to lead and facilitate processes through influence and collaboration.
• Demonstrated problem-solving skills and initiative to analyze and disseminate relevant credentialing data across internal company departments.
• Ability to make priority determinations without direct supervision.
• Informational research skills, with ability to analyze, interpret and draw inferences from research findings, and prepare reports.
• Ability to use independent judgment to manage and impart confidential information.
• Database management skills including querying, reporting, and document generation.
• Working knowledge of Medical Terminology.
• Strong organization and verbal communication skills, attention to details required.
• Experience working in a rapid-paced startup environment, remaining focused and composed in stressful situations.

Working Conditions and Physical Effort

• No or very limited exposure to physical risk.
• No or very limited physical effort required.
• Ability to perform data entry, operate standard office equipment e.g. copiers, fax, etc.

To apply, please complete Gateway's application at: http://grnh.se/73u2nr1