The Credentialing & Contracting Manager will manage the credentialing and contracting function for CHA Medical Management, MSO. The manager will oversee the contracting process for all provider groups. The Manager will facilitate and manage credentialing requirements for all providers within the network of the managed care entity. This includes credentialing incoming providers and re-credentialing of existing providers.
Job Requirements:
- Create contracts from contracting templates for all new provider groups.
- Create LOAs/MOUs as needed.
- Ensures compliance with accreditation and regulatory requirements through proper handling of both existing and incoming providers.
- Ensures compliance with accreditation and regulatory requirements through proper handling of credentialing for a medical facility.
- Oversees the credentialing and re-credentialing documents and related data as per NCQA guidelines.
- Coordinate with the providers, provider partners, management, and other related parties to facilitate the credentialing process.
- Supervise members of the credentialing and contracting team, if any, in handling electronic and non-electronic documents for credentialing and contracting.
- Supervise and manage resources used for processing credentialing and re-credentialing.
- Lead credentialing committee meetings on a monthly to quarterly basis.
- Maintain and update Credentialing Policies and Procedures.
- Maintain strict confidentiality in handling the credentialing documents and processes.
- Manage and maintain provider and facility records necessary to keep track the credentialing, re-credentialing, and other compliance requirements.
- Manage and negotiate contracting agreements with providers.
- Respond to inquiries from providers, management, health plans, and other parties regarding credentialing and contracting for providers and facilities.
- Serves as the primary point of contact for all credentialing and contracting inquiries for both internal and external parties.
- Collaborates with colleagues and leadership to identify and implement best practices.
- Perform annual credentialing Health Plan audits with affiliated plans.
- Hires, trains counsels and supervises staff, if any.
- Other duties as assigned.
Minimum Education
- Bachelor’s degree required, OR four (4) years of experience in a directly related field.
- High School Diploma or General Education Development (GED) required.
Preferred Education
- N/A
Minimum Work Experience and Qualification
- Minimum five (5) years of experience in health care in an administrative or managerial position related to credentialing and managed care.
Preferred Work Experience and Qualification
- Minimum three (3) years of supervisory experience preferred.
- Certification in the area of credentialing and/or Quality experience is preferred.
Required Licensure, Certification, Registration or Designation
- LA County Fire Card
DISCLAIMER: The above statements are intended to describe the general nature and level of work being performed by incumbents assigned to this job. This is not intended to be an exhaustive list of all the responsibilities, duties and skills required. The incumbent may be expected to perform other duties as assigned.
COMPLIANCE & INTEGRITY: Consistently supports compliance and the CHA Medical Management Code of Conduct by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state and local laws and regulations, accreditation and licensure requirements (if applicable), and CHA Medical Management’s policies and procedures.
Models and reinforces ethical behavior in self and others in accordance to the Code of Conduct; adheres to organizational policies and guidelines; supports compliance initiatives; maintains confidences; admits mistakes; conducts business with honesty; shows consistency in words and actions; follows through on commitments.
All Directors, Managers and Supervisors are accountable for communication, implementation, enforcement, monitoring and oversight of compliance policies and practices in their departments.
SERVICE & QUALITY: In addition to defined technical requirements, accountable for consistently demonstrating service behaviors and principles defined by the CHA Medical Management, as well as specific departmental/organizational initiatives. Also accountable for consistently demonstrating the knowledge, skills, abilities, and behaviors necessary to provide superior and culturally sensitive service to each other, to our patients, and to purchasers, contracted providers and vendors.
WORKPLACE SAFETY: In addition to defined working conditions and physical requirements, employees are accountable for working safely; following established policies & procedures; utilizing all designated protective personal equipment (PPE) and/or safety equipment assigned for task; and reporting all injuries and hazards to their supervisor immediately.
Supervisors and Managers are accountable for ensuring the safety performance of employees; applying consistent practices in compliance with federal, state and local regulations; providing guidance to maintain a safe and healthy work environment
CHA Medical Management is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the Los Angeles Fair Chance Ordinances.