Manager, ASC Credentialing (32615)

POSITION PURPOSE

The Manager, ASC Credentialing and Payer Operations, is responsible for the oversight of the ASC facility credentialing and recredentialing application process with all health plans. This position is also responsible for ensuring compliance with credentialing guidelines and understanding the credentialing processes for each of the health plans with which GI Alliance is contracted.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Ensure accurate and timely completion, submission, and follow-up on all outstanding credentialing/recredentialing applications with payers and ASC locations.
• Collect primary source verification documentation for initial credentialing, including licensing, board certifications, proof of professional liability insurance, and other necessary documents.
• Establish and maintain positive working relationships with payer representatives, ASC medical staff, internal departments, and providers.
• Maintain credentialing database and ensure information is up to date at all times.
• Notify staff upon completion of provider credentialing and plan participation status for scheduling and billing purposes.
• Prepare and maintain Standardized Credentialing Application, CAQH, and Availity for all providers.
• Complete NPPES (NPI), PECOS (CMS), and Texas Medicaid applications.
• Verify that all ASC credentialing requirements are met.
• Responsible for monthly submission of provider roster to health plans and timely communication of group additions, changes, and terminations.
• Stay abreast of regulatory requirements.
• Adhere to HIPAA privacy regulations.
• Perform other duties as assigned.

KEY COMPETENCIES

• Experience in ASC and individual provider credentialing
• Experience in credentialing of major payers such as Medicare, Medicaid, Tricare, BCBS, Aetna, Cigna, Humana, and other commercial and managed plans
• Knowledge of state and payer specific guidelines
• Experience in creating CAQH, NPI, and PECOS profiles and applications
• Detail oriented and capable of exploring innovative solutions to solve complex problems
• Ability to work independently and maintain a positive attitude
• Ability to manage multiple and simultaneous responsibilities
• Ability to maintain confidentiality of all medical, financial, and legal information
• Ability to complete work assignments accurately and in a timely manner
• Ability to communicate effectively, with excellent verbal and written communication and customer relation skills
• Strong organizational skills

QUALIFICATIONS

• Minimum of five (5) years' ASC credentialing experience
• Proficiency with computer systems and Microsoft Office (Word & Excel) required