Job description

The Credentialing Account Manager is a member of the quickly growing PMG Credentialing Team, and will be responsible for performing timely and accurate initial credentialing of providers; ensuring applications comply with requirements and identifying providers that are due for re-credentialing. This person needs to be well organized, able to multi-task, meet deadlines and interface professionally with PMG staff, as well as our individual clients. The ideal candidate would be an analytical thinker, strong communicator and possess a positive attitude.

Essential Duties & Responsibilities:

• Coordinating and gathering all necessary information for the successful set-up of new clients, groups and providers by professionally acquiring information from the provider or office staff.
• Compiling and maintaining current and accurate data for all providers in the PMG credentialing database, including data entry for all new clients into credentialing software.
• Completing provider initial and re-credentialing applications, provider change forms and letters and successfully following up with Third Party insurance carriers as needed.
• Maintaining copies of current state licenses, DEA certificates, malpractice factsheets, while tracking said requirement’s validity.
• Acting as first point of contact for PMG Credentialing clients; frequent email and phone communication.
• Assisting in the auditing of health plan directories as well as CAQH to ensure practice/provider demographics remain accurate and current.
• Leading client conference calls and presenting material effectively to clients.
• Interfacing regularly with PMG Departments and Credentialing Clients regarding credentialing related inquiries and operations issues.
• Maintaining confidentiality with regards to any disciplinary actions or malpractice suits.
• Providing first-level reporting out of credentialing software.
• Assisting the Credentialing Team with additional administrative tasks, as assigned.

Supervisory Responsibilities:

• Credentialing Account Managers receive general supervision - routine duties are performed with minimal supervision; standard practices or procedures allow CAM’s to proceed alone at routine work; occasional check of work while in progress; work is reviewed upon completion.
• Credentialing Account Managers are supervised by and report to the Senior Manager of Credentialing Operations.

Qualifications

Summary of Qualifications:

• High School Diploma or GED required; Associate’s Degree / strongly preferred.
• A minimum two years of relevant experience in credentialing, provider enrollment, or related field required.
• Proficient use of Microsoft Office applications (Excel, in particular), internet resources and Adobe Acrobat.
• Complying with HIPAA policies, PMG Policies and federal/state laws

Core Competencies:

• Action Oriented - Enjoys working hard; is action oriented and full of energy for things he/she sees as challenging; not fearful of acting with a minimum of planning; seizes more opportunities than others.
• Customer Focus - Is dedicated to meeting the expectations and requirements of internal and external customers, gets first hand client information and uses it for improvements in products and services; acts with clients in mind; establishes and maintains effective relationships with clients and gains their trust and respect.
• Integrity & Trust - Is widely trusted; is seen as direct, truthful individual; can present the unvarnished truth in an appropriate and helpful manner; keeps confidences; admits mistakes; doesn’t misrepresent him/herself for personal gain.
• Ethics & Values- Adheres to an appropriate and effective set of core values and beliefs during both good and bad times; acts in line with those values; rewards the right values and disapproves of others; practices what he/she preaches
• Composure - Is cool under pressure; does not become defensive or irritated when times are tough; is considered mature ; can be counted on to hold things together during tough times; can handle stress ;is not knocked off balance by the unexpected ; doesn’t show frustration when resisted or blocked; is a settling influence in a crisis
• Teamwork - Promotes team and departmental teamwork

Job Specific Competencies:

• Conflict Management - Steps up to conflicts, seeing them as opportunities; reads situations quickly; good at focused listening; can hammer out tough agreements and settle disputes equitably; can find common ground and get cooperation with minimum noise.
• Problem Solving - Uses rigorous logic and methods to solve difficult problems with effective solutions; probes all fruitful sources for answers; can see hidden problems; is excellent at honest analysis; looks beyond the obvious and doesn't stop at the first answers.
• Decision Quality- Makes good decisions (without considering how much time it takes) based upon a mixture of analysis, wisdom, experience, and judgment; most of his/her solutions and suggestions turn out to be correct and accurate when judged over time; sought out by others for advice and solutions.
• Written Communications- Is able to write clearly and succinctly in a variety of communication settings and styles; can get messages across that have the desired effect.
• Process Management - Good at figuring out the processes necessary to get things done; knows how to organize people and activities; understands how to separate and combine tasks into efficient work flow; knows what to measure and how to measure it; can see opportunities for synergy and integration where others can't; can simplify complex processes; gets more out of fewer resources.
• Presentation Skills- Is effective in a variety of formal presentation settings: one-on-one, small and large groups, with peers, direct reports, and bosses; is effective both inside and outside the organization, on both cool data and hot and controversial topics; commands attention and can manage group process during the presentation; can change tactics midstream when something isn't working.

Physical Requirements:

Necessitates fine motor skills; occasionally requiring pushing, pulling, lifting and carrying up to 15 lbs. Must be able to use a computer, including keyboard and telephone, during peak activity periods, in excess of 8 hours per day and/or 40 hours per week. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions.

Job Type: Full-time

Pay: $23.00 - $26.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Flexible spending account
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Experience:

• provider enrollment/credentialing: 3 years (Required)

Work Location: Remote

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