Manager, Ambulatory Credentialing

Lovelace Medical Group Admin

Full Time

Albuquerque, NM 87110

Posted

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Job description

Overview:

Join our Lovelace Medical Group team as a day shift, full time Manager, Ambulatory Credentialing!

Lovelace Health System (LHS) has been committed to meeting the growing healthcare needs of the Albuquerque community since 1912. LHS is comprised of Lovelace Medical Center, Heart Hospital of New Mexico at Lovelace Medical Center, Lovelace UNM Rehabilitation Hospital, Lovelace Women’s Hospital, Lovelace Westside Hospital, Lovelace Regional Hospital, New Mexico Heart Institute and Lovelace Medical Group. LHS has 613 licensed beds.

Under limited supervision, oversees the operations of the Ambulatory Credentialing department to develop, manage and monitor processes and procedures that support the credentialing, re-credentialing, expirable data management, and delegated credentialing contract processes. Oversees all of the credentialing 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.

Responsibilities:

1) 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.

2) Coordinates the management of the electronic credentials application, to ensure distribution, receipt, processing, and timely delivery to health system entity.

3) Coordinates the management of the expirable process to ensure all clinical provider licenses and certificates remain current, ensuring appropriate notification prior to expiration.

4) 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.

5) Prepares for and coordinates credentialing audits in compliance with the managed care delegated credentialing contracts.

6) Functions as primary credentials contact for all internal and external inquiries; develops and maintains positive working relationships.

7) Oversees the supervision of personnel, which includes 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.

8) Represents credentialing 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.

9) Cooperates and interacts with supervisors, peers, other departments, and all customer groups demonstrating our commitment to “service.”

10) Performs miscellaneous job-related duties as assigned.

Qualifications:

Education

Minimum: Bachelor’s Degree in related field of study. Relevant education and/or experience may be substituted for one another in accordance to policy.

Desired:

Knowledge/Skills/

Abilities

Knowledge of related accreditation and certification requirements.
Knowledge of medical credentialing and privileging procedures and standards.
Knowledge of medical staff policies, regulations, and the legal environment within which they operate.

Experience

3 years of experience directly related to the duties and responsibilities specified

Licensure

NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS) or actively pursuing certification preferred.

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Manager, Ambulatory Credentialing

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