In this role, the Credentialing Manager is responsible for overseeing all aspects of credentialing and re-credentialing of our healthcare providers.  This position ensures all providers are appropriately credentialed, which includes the responsibility of maintaining current information on file and within the credentialing database, Modio.

The following duties and responsibilities generally reflect the expectations of this job but are not intended to be all inclusive. The essential functions include the most significant tasks and are the essence of why the role exists; removing an essential duty would fundamentally alter the role.

• Oversee the processing of timely applications and reapplications for doctors and advanced practice providers (APP) to ensure compliance with national accreditation standards and state and federal regulatory requirements.
• Develop and implement policies and procedures for the credentialing and recredentialing process, ensuring they meet industry standards and organizational needs.
• Perform and collect PSV (primary source verification) documentation for licensing, board certifications, proof of professional liability insurance, National Practitioner Data Bank (NPDB) and/or other sources as required based on NCQA standards, payer requirements and company credentialing policies.
• Facilitate the resolution of delays, discrepancies, or concerns regarding applicants’ credentials, working closely with the provider, practice manager, and the leadership team
• Maintain accurate and confidential credentialing databases and files, ensuring up-to0date information is obtained at all times, and upholding the security and integrity of sensitive provider information.
• Liaise with external agencies, including payers and regulatory bodies, to ensure the timely sharing of credentialing information and compliance with external standards.
• Oversee the auditing of credentialing processes and documentation to identify areas for improvement and ensure adherence to accreditation standards and best practices.
• Provide regular reports and updates to leadership team and practices.
• Manage tasks, processes, and workflows of team. Provide coaching and mentorship to team to continue to elevate the department’s ability to support the continued growth of the organization.
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Knowledge, Skills, and Abilities:

• Bachelor’s degree in Health Administration, Business, or related degree.
• Minimum of 5 years of credentialing experience.
• Minimum of 3 years supervisory or management level experience in credentialing.
• Solid working knowledge of healthcare regulations and standards, including state and federal laws governing healthcare professionals and facilities, as it relates to credentialing of providers.
• Superior attention to detail and follow through skills. Quickly spot errors or inconsistencies in applications / forms.
• Clear, effective, and proactive written and verbal communication skills.
• strong coaching and leadership skills.  Actively listen, coach, solve problems, and manage conflicts in dynamic and stressful environments.
• Certified Provider Credentialing Specialist or equivalent certification preferred.
• Previous experience working in Modio preferred.

Why Together Women’s Health (TWH)?

Because we do things a bit differently here. We’re a rapidly growing network of Obstetrics and Gynecology practices, and while it’s important to know what we are, it’s more important to know what drives us - our mission is to improve the lives of our healthcare partners and their patients. Our actions speak louder than those words. We invest in our talented teams and our connection to our core values last longer than a quick glance through the employee handbook - we live them every day! TWH is a place where careers thrive for those who believe the right team can achieve anything.

Together Women’s Health (TWH) is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.