Assistant Director - ProCred

ProCred is currently seeking an Assistant Director as an addition to the provider enrollment and credentialing team. The Assistant Director works closely with the Director of Operations to coordinate and supervise the work of all employees. The Assistant Director will support the Director of Operations in managing the day-to-day business operation activities. The Assistant Director administers the physician and mid-level payer enrollment and hospital privilege credentialing applications process. The Assistant Director is responsible for preparing and submitting credentialing applications and supporting documentation for the purpose of enrolling individual providers and clients with payers and hospitals. In this role, you will ensure the Credential Department properly and in a timely manner prepares and submits applications of insurance participation, follows up on the status of applications and tracks the progress on all pending applications. PRINCIPAL DUTIES AND RESPONSIBILITIES: Assists in department's work queues and tracking reports to ensure timely submission of credentialing documents Screening practitioners’ applications and supporting documentation to ascertain their eligibility Collecting information from the National Practitioner Data Bank (NPDB), the applicant and their malpractice insurer, and other Primary Source Verifications Ensuring all information is entered in our data system accurately and in a timely manner Assist with NCQA recertification process Assists in developing and implements standardized guidelines Provide leadership, training, and review credentialing to assist in the evaluation performance of credentialing leads and specialists Manage, identify, research, resolve, and report any issues involving daily workflow and quality of work to the Director of Operations Works with Director of Operations to ensure compliance guidelines are established consistently throughout organization Participates in and/or supports the Orientation of newly hired staff members Maintains both internal and external customer and client relationships as required and manages expectations related to the performance of deliverables and non-standard issue resolution. Maintain compliance with Federal and State regulations Assist in conducting weekly, bi-weekly, monthly credentialing calls with clients and team member Budget Management for depa1tment Process Improvement for department Assists in training of new hire staff Oversee credentialing data needed for onboarding, contracting, and other related purposes. Credentialing data includes but is not limited to the medical degree, Drug Enforcement Administration (DEA) number, state license number, Board certifications, malpractice insurance and state insurance form Works closely with providers and practice managers to obtain missing documentation pertaining to the onboarding and reappointment process. Obtains required provider signatures and follows up with the entities on documentation submitted. Maintains provider information and demographics for all providers Responds to internal and external inquiries on routine credentialing and contracting matters Monitors and advises clients on expirations including but not limited to: Medical License, DEA, CDS, COI, Board Certification Maintain quarterly health plan rosters Create & maintain provider CAQH Maintains workflow processes for all commercial and government payors EXPERIENCE: Credentialing: 7 years (Preferred) Provider Enrollment: 7 years (Preferred) Microsoft suites (Excel, Outlook) 5 years (Preferred) Managed Health Plan Provider Enrollment: 3 years (Preferred) Leadership: 3 years (Preferred) National Committee for Quality Assurance (NCQA) Standards, state regulations, and Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards (Preferred) Credential Stream platform PECOS: 5 years (preferred)