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Manager, Credentialing Verification Office

Requisition ID:

21154946

Business Unit:

Hartford HealthCare Corp.

Location:

Wethersfield, CT

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Description

Job Schedule: Full Time
Standard Hours: 40
Job Shift: Shift 1
Shift Details: 40hrs per week

Work where every moment matters.

 Every day, almost 30,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here.  We invite you to become part of Connecticut’s most comprehensive healthcare network.

The story of Hartford HealthCare is the story of transformation – from a handful of disconnected organizations a decade ago to a unified system with a shared, value-based culture of accountability and innovation.  The healthcare landscape has become highly competitive, with new players and disruptive technology and we are working to expand and create our system’s organizational, leadership, cultural, and talent capabilities to ensure Hartford HealthCare will always be the first choice of the people we serve

The Credentialing Verification Office Manager provides oversight for the System Credentialing Verification Office and provides supervision for department staff in central and remote locations.  Responsibilities include but, are not limited to the following:

  • Oversees the credentialing function for provider enrollment in payor plans, and for applications and reapplications to the medical staff, including requests for clinical privileges. 
  • Assures the timely processing of applications in accordance delegated credentialing agreements from payors, hospitals and ICP.  
  • Assures compliance with hospital specific bylaws, ICP bylaws, and regulatory standards.
  • Prioritizes applications in the queue, and assigns work to various staff within the department. 
  • Oversees the maintenance of multiple credentialing databases, assuring accuracy and appropriate modifications to facilitate interfaces and report generation for internal and external customers. 
  • Oversees document collection for primary source verification. Provides quality control for files that are presented to the local hospital credentialing functions.
  • Coordinates the provider enrollment function for the system.
  • Ensure timely enrollment of providers with multiple payers to ensure reimbursement. This role must interface with all providers that are enrolling, multiple HHC and payor representatives to deliver timely outcomes
  • Oversees the system requirements for facility credentialing function for various payors.  
  • Assures efficient management of expirables tracking (licenses, registrations, etc.) with appropriate follow up. 
  • Interacts on a regular basis with applicants (physicians and advanced practitioners, medical staff leadership, regulatory agencies, healthcare facilities.
  • Maintains and can communicate a thorough knowledge of the medical staff bylaws, ICP bylaws, regulatory and accrediting standards.  

Qualifications

Education:

  • Associate’s Degree required. Bachelor’s Degree strongly preferred.

Experience: 

  • 5  years of related experience in hospital credentialing and/or provider enrollment
  • Previous leadership experience strongly preferred
  • Certified Professional Medical Services Management (CPMSM),required within first year

We take great care of careers.

With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth. Here, you are part of an organization on the cutting edge – helping to bring new technologies, breakthrough treatments and community education to countless men, women and children. We know that a thriving organization starts with thriving employees-- we provide a competitive benefits program designed to ensure work/life balance. Every moment matters. And this is your moment.

 
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