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Credentialing Manager

FL 32117
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J Daytona Employment is currently recruiting for a Credentialing Manager

Jo Job Description: Credentialing Manager

The Credentialing Manager is a responsible for managing the credentialing department. Ensuring all aspects of the credentialing and re-credentialing for all medical providers, dental providers and behavioral health providers is being completed by each team member as assigned. The Credentialing Manager will have daily interaction with clients and billing operations in support of credentialing needs that arise.

Summary of Duties: To communicate with clients about the credentialing activities of the account. They will have the responsibility of the oversight of all credentialing account activities for the client. They will attend weekly phone meetings with the clients to communicate any credentialing needs or concerns.

Supervisor: Reports directly to the Operations Manager.

Essential Functions:

  1. Ensure the overall health of the client is exceeding expectations by reviewing the maintenance of the Credentialing Reports, such as Progress Report, Open Items, Demographic Sheet, and Matrix.
  2. Communicate with the clients to resolve or explain any questions they may have.
  3. Attend weekly meetings with client and management.
  4. Attend at risk and integration client calls.
  5. Maintain expert knowledge of HRSA, CAQH, PECOS and NPPES.
  6. Accurately complete provider applications and/or link letters.
  7. Communicate with payers to verify applications have been received, processed and providers are in network.
  8. Conduct team meetings and training sessions for the credentialing department.
  9. Management of credentialing team members time cards and attendance perform daily spot checks on credentialing employees and monitor performance through continuous feedback and delivering performance reviews.
  10. Maintain strictest confidentiality; adhere to all HIPAA guidelines/regulations.
  11. Ensure commitments to clients are met.
Education: High School Diploma or GED required. Credentialing certificate or previous experience as a credentialing specialist, supervisor or manager required.


  1. At least (2) two years of credentialing experience
  2. A background in FQHC and/or medical facility required.
  3. Knowledge of medical insurance credentialing practices.
  4. Knowledge of insurance credentialing forms.
  5. Knowledge of business office procedures.
  6. Comprehensive understanding of how to process paper and electronic credentialing forms.
  7. Ability to operate a computer and basic office equipment.
  8. Ability to operate a multi-line telephone system.
  9. Intermediate skill using Microsoft Office suite
  10. Ability to establish and maintain effective working relationships with insurance company representatives, colleagues, clients and patients if needed.
  11. Must be well organized and detail oriented.
  12. A positive attitude.
  13. A strong desire to succeed.
  14. Excellent communication skills, both written and oral.
Environmental/Working Conditions: Normal office environment. Occasional overtime may be required and/or hours may be shortened as business needs dictate.

Physical Demand: Requires sitting and standing associated with a normal office environment. Manual dexterity needed for using a calculator and computer keyboard.