Credentialing Provider Data Manager

Community Medical Services - Scottsdale, AZ

Full-time - Mid Level

Remote - Scottsdale, AZ

Ambulatory Health Care Services

About the position

The Credentialing Provider Data Manager at Community Medical Services is a hybrid role responsible for overseeing the credentialing, re-credentialing, and payer enrollment processes for all providers and facilities. This position involves implementing and reengineering processes for capturing and integrating provider and facility data across various systems, including EMRs, EHRs, and a credentialing database. The role requires strong leadership and management skills to ensure timely application submissions and effective data management strategies, all while contributing to the mission of supporting individuals with substance use disorders.

Responsibilities

• Lead, manage, and ensure timely review and submission of applications by the Credentialing Supervisor and Credentialing Administrators.
• Develop and implement procedures for managing Credentialing and Provider Data integration across multiple systems.
• Create rules and procedures for data sharing.
• Regularly monitor and evaluate information and data systems that could affect analytical results.
• Assess system performance and make recommendations for credentialing and provider data software.
• Manage all incoming provider and facility data files.
• Prioritize and manage multiple tasks and responsibilities efficiently, exercising strong delegation skills.
• Develop data management strategies continually.
• Maintain copies of current state licenses, DEA certificates, malpractice coverage, and other required credentialing documents for all providers.

Requirements

• Bachelor's degree in computer science, public health, healthcare administration, or a related field.
• A minimum of 5+ years' experience in credentialing and provider data management.
• Experience with multi-state credentialing and provider enrollment.
• At least 2 - 4 years managing direct reports.
• Familiarity with the healthcare/medical industry is required.
• Ability to decipher and organize large amounts of data.
• An analytical mindset with superb communication and problem-solving skills.
• Ability to translate complex problems clearly and in nontechnical terms.
• Knowledge of NCQA standards and payer credentialing standards required.
• Excellent interpersonal, oral, and written communication skills required.
• Strong computer, data entry, and analysis skills required.
• Proficiency in Microsoft Excel and Microsoft Access for at least 5 years.

Benefits

• Health savings account
• Paid holidays
• Disability insurance
• Health insurance
• Dental insurance
• Employee assistance program
• Vision insurance
• 401(k) matching
• Life insurance