Strive Health Credentialing Manager in Denver, Colorado
Strive Health is built for purpose- to transform a broken kidney care system. We are fundamentally changing the lives of kidney disease patients through early identification and engagement, comprehensive coordinated care, and home-first dialysis. Strive’s model is driven by a high-touch care team that integrates with local providers and spans the entire care journey from CKD through ESRD, leveraging comparative and predictive data and analytics to identify patients at risk. Strive Health’s interventions significantly reduce the rate of emergent dialysis crash, cut inpatient utilization, and significantly improve patient outcomes and experience. Come join our journey as we create THE destination for top talent in the Healthcare community and set a new standard for how care kidney should be done.
Under limited supervision, oversees the operations of Strive Health to develop, manage and monitor processes and procedures that support the credentialing, re-credentialing, and expirable data management. Oversees the credentialing staff and functions including application management and primary source verification. Ensures compliance with the appropriate accrediting and regulatory agencies. Supervises credentialing staff in the day-to-day management of the overall credentialing process and database management.
Manages the credentialing process for all Strive Health clinical providers in accordance with all state and federal laws.
Coordinates the management the credentialing database and associated modules, ensuring accuracy of data and reporting to downstream systems. Monitors critical data for extensive analysis and report generation.
Coordinates the management of the electronic credentials application, to ensure distribution, receipt, processing, and timely delivery to health system entity.
Coordinates the management of the expirable process to ensure all clinical provider licenses and certificates remain current, ensuring appropriate notification prior to expiration.
Monitors and reports turnaround times for processing of credentials applications, with continued focus on delivery of a high-quality product, with the greatest efficiency, in the least amount of time,
Provides leadership with credentialing updates as it relates to credentialing practices and services; prepares and conducts credentialing orientations and provides updates as appropriate on new policies and procedures.
Prepares for and coordinates credentialing audits in compliance with the managed care delegated credentialing contract
Functions as PSV credentials contact for all internal and external inquiries; develops and maintains positive working relationships.
Oversees the supervision of personnel, which includes hiring qualified candidates to expand the team, work allocation, training, promotion, enforcement of internal procedures and controls, and problem resolution; evaluates performance and makes recommendations for personnel actions; motivates employees to achieve peak productivity and performance.
Represents the credentialing function to internal and external customers as appropriate; makes presentations to and interacts with various internal and external customers on issues pertinent to area of specialty.
Bachelor’s degree in business or related field and/or equivalent work experience
5 years credentialing experience preferred for a health plan and or large healthcare entity such as a hospital
5 years’ experience in a medical practice business office role required
Experience with various clinical provider credentialing processes, as well as healthcare entity credentialing with major payers such as Medicare.
Familiar with credentialing platforms and CAQH requirements
Working knowledge of NCQA Credentialing accreditation requirements and processes
Knowledge of provider credentialing and its direct impact on the practice’s revenue cycle
Excellent computer skills including Excel, Word, and Internet use
Detail oriented with above average organizational skills
Plans and prioritizes to meet deadlines
Excellent customer service skills; communicates clearly and effectively
Annual Salary Range: $92,000.00 - $102,000.00
Strive Health is an equal opportunity employer and drug free workplace. At this time Strive Health is unable to provide and work visa sponsorship. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law. Please apply even if you feel you do not meet all qualifications. If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to firstname.lastname@example.org
External Company URL: https://strivehealth.com/
Street: 1600 Stout Street
Remote Position: Yes