1+ months

MGR - CREDENTIALING & PAYER RELATIONS - (121832)

Universal Health Services
Malvern, PA 19355
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  • Job Code
    121832

At Independence Physician Management (IPM a subsidiary of UHS Inc.) we are looking for exceptional people who share our vision and values, who share our focus on hard work, enthusiasm, teamwork, loyalty, trust and cooperation. We've embraced these traits and built a team of employees who consistently work to achieve the highest level of service excellence. People are our most valuable resource at IPM as we are committed to providing high quality acute care and behavioral health services to residents of the communities we serve. We are equally committed to offering our employees unlimited opportunity in an environment that encourages professional development.

By administering credentialing services and payer relations throughout our nationwide practices, the Credentialing and Payer Relations Manager is responsible for maintaining the overall efficiency and effectiveness of the Provider Credentialing and Payer Relations department. Manages a team of Credentialing Specialists who are accountable for provider health plan enrollment processes to ensure compliance with the organizational as well as health plans regulatory and accrediting credentialing requirements and procedures. Works to streamline the entire enrollment process to help ensure minimal write-offs in the timeframe for health plan approvals and accounts receivable. Conducts regularly quality control audits of files and take necessary actions to remediate and prevent future errors. Ensures that NCQA certification is maintained in order to enable delegated credentialing for payers that have provisions for such in the contact. Manages the Payer Relations team overseeing relationships with our contracted payers and assists in the analysis of payer issues that impact the revenue cycle. Builds relationships with the payers and is able to handle escalated issues that have not been resolved in a timely manner. Ensures that payer changes that impact the revenue cycle are communicated to CORE and the markets in a timely manner. Ensures teams active participation in COREs denials committee and monitors work items for prompt resolution.

  • Oversees the infrastructure of the credentialing process to ensure optimal workflows are realized and utilized.
  • Manages the quality and timeliness of the work being done and leads efforts to streamline the process and inject automation where possible.
  • Performs root-cause analysis for credentialing issues that negatively impact the revenue cycle. Identifies and implements viable solutions in a timely manner.
  • Ensures that all standards are met to maintain NCQA accreditation for delegated credentialing where payers have provisions for such in IPMs contacts.
  • Keeps pace with all regulatory changes regarding delegated credentialing and provider enrollment and works internally to modify systems and processes to mitigate any negative impact to revenue
  • Meets with direct reports on a routine basis for one on ones.
  • Provides performance feedback, and coaches/counsels direct reports as needed.
  • Documents performance deficiencies when needed.
  • Effectively communicates process change and solutions to team.
  • Consistently demonstrates strategic thinking to ensure that the course of the Credentialing and Payer Relations department keeps pace with industry standards and best practices.
  • Develops key performance indicators with IPM market leadership to identify trends, track results and identify opportunities for process improvement, enhanced performance and maximized revenue.
  • Monitors payer issues to ensure timely resolution.
  • Trends issues by payer to call out and closely manage those payers with higher volumes of unnecessary denials and other deficiencies.
  • Keeps lines of communication open with the payers and follows an escalation process when issues are not being resolved by payers in a timely manner.
  • Manipulates data in Excel to provide user-friendly reports that meet the needs of broad audiences.
  • Knows what to report and how to generate the data in order to monitor overall performance of the department and progress towards goals and standards.
  • Performs other duties and works on special projects as requested
Job Requirements

Education: Bachelors degree preferred but commensurate work experience in progressively responsible administrative/leadership positions will be considered.

Work Experience: Minimum of 5-8 years hands-on credentialing and/or payer relations experience in a health care setting including physician networks, health insurance, and governmental regulation of health care companies preferred. Minimum 3-5 years of direct supervisory experience managerial or administrative experience required.

Knowledge: Knowledge of current NCQA Standards. Comprehensive knowledge of the managed care industry, with specific emphasis on physician credentialing and/or physician contracting requirements. Understanding of revenue cycle and ability to analyze issues within the revenue cycle.

Skills: Ability to communicate effectively both verbally and in writing. Results oriented with a proven track record of accomplishing tasks, analysis of payer issues that impact the revenue cycle, problem solving, deadline oriented and being responsive. Ability to adapt to change and meet deadlines, demonstrated attention to detail and high degree of accuracy.

Travel Requirements: Minimal travel may be necessary.

If you meet the above requirements and are looking for a rewarding career, please take a moment to share your background with us by applying online. Independence Physician Management offers competitive compensation commensurate with experience and benefit programs including medical, dental, life insurance, and 401(k).
Independence Physician Management is not accepting unsolicited assistance from search firms for this employment opportunity. Please, no phone calls or emails. All resumes submitted by search firms to any employee at IPM via email, the Internet or in any form and/or method without a valid written search agreement in place for this position will be deemed the sole property of Independence Physician Management. No fee will be paid in the event the candidate is hired as a result of the referral or through other means.


Posted: 2020-02-01 Expires: 2020-04-02

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MGR - CREDENTIALING & PAYER RELATIONS - (121832)

Universal Health Services
Malvern, PA 19355

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