Lumeris Credentialing Manager in St. Louis, Missouri

In order to apply for a position at Lumeris, you must create an account using your email address and a password of your choosing. This account will allow you to receive notifications each step of the way through the job application process. With these updates, you’ll never have to wonder where you are in the process. Additionally, we can easily send pertinent documents to you for your review. Once you create the account, you may apply to any position you feel is a good fit without having to re-enter information. Thank you for your interest in Lumeris.

Position:

Credentialing Manager

Position Summary:

The Credentialing Manager is accountable for the development, management and monitoring of processes and procedures that support credentialing, re-credentialing, and delegated credentialing. In this position, the Credentialing Manager will lead a credentialing team and ensure compliance with the appropriate accreditation standards and applicable regulations.

Job Description:

Role and Responsibilities

  • Evaluate trends in credentialing application processing and provide reports to appropriate committees

  • Communicate effectively with providers, facilities and credentialing contacts in order to assist with resolving credentialing issues such as with missing information

  • Conduct ongoing monitoring of provider sanctions and license actions

  • Facilitate the process for preparing for Credentialing Committee meetings and completing any communications about credentialing status

  • Collaborate with credentialing software and application vendors to maximize the use of the information available

  • Collaborate with other departments to ensure that providers are credentialed, contracted and entered into the network effectively

  • Develop, maintain and update the credentialing program policies and procedures and training manual

  • Provide leadership and development opportunities and facilitate ongoing performance conversations for the Credentialing team

  • Educate Credentialing team on best practices and changes in processes

  • Audit credentialing team to validate that policies and procedures are followed

  • Conduct credentialing delegation oversight including pre-delegation and annual delegation audits, and corrective action plan development and monitoring

  • Articulate knowledge and understanding of credentialing policies as well as applicable standards and regulations.

  • Maintain confidentiality of privileged information

  • Perform other duties as assigned

Experience, Qualifications, and Education

  • Associate Degree or Bachelor’s Degree in a health related field preferred

  • 2+ years of experience in Credentialing

  • CPCS (Certified Provider Credentialing Specialist) certification or ability to obtain within one year

  • 2+ years experience managing/supervising employees

  • Demonstrated working knowledge of credentialing standards and regulations

  • Proficiency with credentialing software such as Cactus

  • Proficiency with MS Office applications including Word and Excel

  • Problem solving skills for the identification of issues and the ability to develop appropriate courses of action

  • Excellent organizational skills for prioritizing tasks to meet set deadlines

  • Excellent verbal and written communication skills

Benefits:

In addition to competitive salaries, challenging work assignments, and developmental opportunities, Lumeris offers employees a comprehensive benefits package to include medical, dental, vision, life insurance, short-term and long-term disability, paid time off (PTO), matching 401K, and tuition assistance.

For more information on Lumeris careers and to apply for positions, please check out our web site: www.lumeris.com/careers

Lumeris is an EEO/AA employer M/F/V/D.

To stay connected with exciting news and the latest job opportunities from Lumeris, follow us on Twitter: @LumerisJobs.

Location:

St. Louis, MO

Time Type:

Full time

Status:

Join Our Growing Team!

Lumeris™ serves as a long-term operating partner for organizations that are committed to the transition from volume- to value-based care and delivering extraordinary clinical and financial outcomes. Lumeris enables clients to profitably achieve greater results through proven playbooks based on collaboration, transparent data and innovative engagement methodologies. Lumeris offers comprehensive services for managing all types of populations, including launching new Medicare Advantage Health Plans, Commercial and Government Health Plan Optimization and Multi-Payer, Multi-Population Health Services Organizations (PHSOs) for provider organizations. Currently, Lumeris is engaged with health systems, provider alliances and payers representing tens of millions of lives moving to value-based care.

Over the past five years, we have tripled in size to more than 800 employees and built the only solution on the market with proven results. Case in point, Essence Healthcare, a long-standing Lumeris client, has earned a 4.5-Star rating or higher for six straight years for the quality of services it provides to its Medicare Advantage (MA) members from the Centers for Medicare and Medicaid Services (CMS). Essence Healthcare has been leveraging Lumeris for more than a decade to operate its Medicare Advantage plans, which serve upward of 60,000 Medicare beneficiaries in various counties throughout Missouri and southern Illinois.

In early 2016, Lumeris was named the Best in KLAS value-based care managed services provider in the area of client-reported impact on the Triple Aim by KLAS Research. As the industry’s most reliable and effective partner for developing population health management solutions, our success is driving tremendous growth in our company. Join us today in making a real difference in how healthcare is delivered!

Why Join Lumeris?

At Lumeris you will be part of team that is focused on solving a national healthcare problem. And you will have the ability to contribute while working for a purpose. Our environment is fast-paced and change-oriented and is focused on growth and employee engagement. At Lumeris we believe talent is utilized best when given the opportunity to succeed. That is why we have removed the boundaries that inhibit success and focus on fostering an environment that allows employees to utilize their talents.