Lead Credentialing Specialist

Panoramic Health•Quantico, VA

21d

About The Position

Lead Credentialing Specialist will lead the Credentialing team through assistance and coordination with the Credentialing Manager/Director regarding the Credentialing and Payer Enrollment processes. The lead will also ensure that the Credentialing department follows all the professional standards, bylaws, state, and federal regulatory requirements for Panoramic Health providers. This team member will assist in overseeing the day-to-day operations, accounting, personnel, and lead the selection, training, guidance, and development of the Credentialing department staff at Panoramic Health. Responsibilities include: Primary role model of Credentialing and Enrollment Specialists and other Credentialing personnel. Provide a centralized, uniform process, to become credentialed and enrolled as a Panoramic provider. Liaison with participating state health plan payors and applicants to ensure compliance of requirements. Monitor critical data for extensive analysis and report generation with all associated programs. Continually seeking process improvement and workflow production of enrollment/clinic requirements. Verify Tract Manager (Cred Program), with up-to-date information, groups, providers, payors, and contacts. Assisting with processing of various credentialing/payor applications in a proficient timeframe and manner. Audit all completed enrollments prior to submission to health plans for accuracy and compliance. Assist in developing and maintaining a sound working environment including training, development, motivation, and review of all personnel on a continual basis. Daily assessment of workload, issues, process, and any questions that need to be addressed and resolved. Monitoring activities as required and necessary and maintenance of department. Perform other duties and responsibilities as required, assigned, or requested.

Requirements

Associates degree; or an equivalent combination of education and/or experience.
Experience in Provider Credentialing, Enrollment, Payors, Health Plans, Healthcare.
Knowledge of credentialing, accreditation, certification, regulations, and applicable state requirements.
Experience in and including training, prioritizing, and scheduling work assignments.
Procedural judgements and conclusions with skills in developing policy and procedure documentation.
Process improvement and implementation including time management and organization.
Investigate and analyze information and formulate conclusions for improvement.
Strong interpersonal and effective communication skills with a diverse community.
Ability to remain a constant resource for teammates, clinics, management, and business.
Creating and inspiring the team environment with an open communication culture.

Responsibilities

Primary role model of Credentialing and Enrollment Specialists and other Credentialing personnel.
Provide a centralized, uniform process, to become credentialed and enrolled as a Panoramic provider.
Liaison with participating state health plan payors and applicants to ensure compliance of requirements.
Monitor critical data for extensive analysis and report generation with all associated programs.
Continually seeking process improvement and workflow production of enrollment/clinic requirements.
Verify Tract Manager (Cred Program), with up-to-date information, groups, providers, payors, and contacts.
Assisting with processing of various credentialing/payor applications in a proficient timeframe and manner.
Audit all completed enrollments prior to submission to health plans for accuracy and compliance.
Assist in developing and maintaining a sound working environment including training, development, motivation, and review of all personnel on a continual basis.
Daily assessment of workload, issues, process, and any questions that need to be addressed and resolved.
Monitoring activities as required and necessary and maintenance of department.
Perform other duties and responsibilities as required, assigned, or requested.