Credentialing Manager

Job Summary

The Indiana Credentialing Manager is responsible for all aspects of the credentialing, re‑credentialing and privileging processes for all medical providers who provide care at Rad Net Indiana and all Eastern locations. The manager will be primarily responsible for all IN imaging center credentialing and payer enrollments and will help with other Rad Net owned and operated facilities as necessary. This position will lead the Indiana Credentialing Team and work with leadership in each local Rad Net market, IN, NY, NJ, DE, MD and FL, including the SVP/VPs of Clinical Operations for each market, Directors of Contracting, Directors of Insurance Verification Teams (IVT), Directors of Patient Service Representatives (PSRs), Directors of Clinical Operations, Charge Capture, AR Management and Data Integrity leadership teams.

The position has a key role in insurance payor relationships at senior levels, driving reimbursement and revenue cycle management efficiencies through compliant credentialing in uniquely designed radiology physician groups, hospitals and health systems, and joint venture environments. The position will follow the latest regulatory and medical policies and procedures, processes and systems in place to support the most efficient credentialing, resulting in maximizing reimbursement and provider and patient satisfaction.

• Responsible for ensuring providers are credentialed, appointed, and privileged with health plans, hospitals and patient care facilities.
• Ensure that the personnel/providers of a Rad Net facility, or Rad Net affiliated professional corporation (PC) are properly trained, licensed and certified as mandated by state and federal regulations and that all services offered by these facilities and providers meet standards set by state and federal government agencies.
• Ensure continued high levels of performance with regulatory, accreditation, and internal requirements including but not limited to CAQH, NCQA, DOI, Medicaid, CMS.
• Provide leadership and oversight of development, documentation and implementation of an IN accreditation plan that includes auditing, coordination of multiple required program processes, such as education and training.
• Lead, manage and ensure that all credentialing specialists review applications, verify both individual and facility accreditation, maintain records of verification and work with auditors as needed.
• Ensure the resolution of Claim Holds, Clearinghouse rejections and denials related to credentialing & provider enrolment issues in a timely manner to avoid delays and loss revenue.
• Maintain copies of all current licenses, DEA certificates, malpractice coverage and any other required documents for all providers.
• Maintain Verity and ECHO OAP databases in which new information or updates to existing information regarding employee training, licenses, education, continuing education and relevant job experience are recorded.
• Ensure that all necessary licenses and credentials are verified and updated for the healthcare facility in which they work, including conducting background checks, contacting licensing boards, reviewing license applications, obtaining education information and interviewing references.

• At least seven years of experience in health‑care credentialing, insurance verification, appeals negotiations and processing in the health‑care industry, health‑care billing/claims processing, and data processing and software operations in the health‑care industry.
• Exceptions to years of experience above may be made given extensive industry‑related experience of at least five years in radiology credentialing and progressive team management experience.
• Require a comprehensive understanding of commercial health plans, Medicare and Medicaid health plans.
• Extensive knowledge of medical coding, CPT and HCPCS codes and ICD‑10, with direct radiology coding knowledge preferred.
• Comprehensive understanding of medical management and health insurance concepts, information management systems and strong analytical and problem‑solving skills are required.
• Bachelor’s degree in healthcare administration highly preferred.
• Strong Excel data‑analysis skills and proficiency with Microsoft Office applications.
• Strong written, verbal and interpersonal communication skills.

• Communicates, cooperates, and consistently functions professionally and harmoniously with all levels of supervision, co‑workers, patients, visitors, and vendors.
• Demonstrates initiative, personal awareness, professionalism and integrity, and exercises confidentiality in all areas of performance.
• Follows all local, state and federal laws concerning employment, including but not limited to: I‑9, Harassment, EEOC, Civil rights and ADA.
• Follows OSHA regulations, Rad Net and site protocols, policies and procedures.
• Follows HIPAA, compliance, privacy, safety and confidentiality standards at all times.