Credentialing Manager

DescriptionJob Summary: The Credentialing Manager will oversee and manage the credentialing and re-credentialingprocesses for all physicians, healthcare providers, and allied health professionals at the LosAngeles Center for Ear, Nose, Throat, and Allergy (LACENTA). The role will ensurecompliance with federal, state, and regulatory requirements while maintaining high standards forquality and efficiency. The Credentialing Manager will be a key part of the operations team andcollaborate closely with clinical staff, administrative departments, and regulatory bodies tofacilitate the smooth onboarding of healthcare providers. RequirementsJob Duties and Responsibilities:

Credentialing Process ManagementOversee and coordinate the credentialing and re-credentialing process for all physiciansand healthcare professionals, ensuring timely submissions to health insurance companies,hospital privileges, and regulatory agencies. ComplianceEnsure all credentialing practices comply with relevant federal, state, and insuranceregulations (e. g. , CMS, NCQA, JCAHO, etc. ). Monitor changes in regulations and applythem to the credentialing processes as needed. Provider Database ManagementMaintain and manage an up-to-date provider database, ensuring accurate records oflicensure, certifications, malpractice insurance, and education. Regularly audit files toconfirm adherence to accreditation standards. Documentation and ReportingPrepare and submit credentialing packets to insurance companies and other relevantparties.

Maintain accurate and complete records of credentialing files for all providers. Insurance ContractingAct as a liaison between the organization and insurance payers to ensure all credentialinginformation is up-to-date and providers are appropriately listed in insurance networks. Assist in managing the enrollment of new providers with health insurance plans. Staff Training and DevelopmentProvide ongoing training for administrative and clinical staff on credentialing processes,documentation, and compliance requirements. Problem ResolutionAct as the primary point of contact for providers and insurance companies with questionsregarding credentialing status. Troubleshoot and resolve issues in a timely manner.

CollaborationWork closely with HR, legal, and clinical departments to ensure that all providers meetthe necessary standards and are in good standing for employment. Assist with onboardingnew hires, ensuring all credentialing paperwork is complete before provider start dates. Qualifications And ExperienceTo perform this job successfully, an individual must be able to perform each essential dutysatisfactorily. The requirements listed below are reflective of the knowledge, skill, and/or abilityrequired. EducationBachelor’s degree in healthcare administration, business, or a related field (or equivalentwork experience).

ExperienceMinimum of 2 years of credentialing experience in a healthcare environment, with astrong background in managing physician credentialing, preferably in a multi-specialtysetting. CertificationsCertification in healthcare credentialing (e. g. , CPCS or CPMSM) preferred. Knowledge And Skills In-depth knowledge of healthcare regulations, including CMS, HIPAA, andinsurance credentialing requirements. Strong organizational and communication skills. Proficiency in Microsoft Office Suite (Word, Excel, Outlook). Experience with credentialing software (e. g. , Echo, Verity, etc. ) is preferred. Strong attention to detail and ability to manage multiple tasks with competingdeadlines. Personal Attributes Self-motivated, proactive, and able to work independently. Strong problem-solving skills and a team-oriented attitude.

High level of confidentiality and professionalism. Physical DemandsThe physical demands described here are representative of those that must be met by anemployee to successfully perform the essential functions of this job. Individual will be requiredTo Sit for long periods at a time. Use hands and fingers in repetitive motions, daily. Ability to lift, push, pull up to 20 lbs. periodically. Travel to clinic locations or sites as needed. Reasonable accommodations may be made to enable individuals with disabilities to