Lumeris Credentialing Manager in St. Louis, Missouri
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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.
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
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.
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St. Louis, MO
XL - FT
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.