At Altais, we’re on a mission to improve the healthcare experience for everyone—starting with the people who deliver it. We believe physicians should spend more time with patients and less time on administrative tasks. Through smarter technology, purpose-built tools, and a team-based model of care, we help doctors do what they do best: care for people.* Provide leadership / coaching to the credentialing team staff, ensuring function initiatives and deliverables are complete and accurate in a timely manner* Responsible for the oversight of processing credentialing applications accurately and promptly in accordance with Credentialing policies and procedures and in full compliance with all regulations with a continued focus on delivery of a high-quality product with the greatest level of efficiency* Owns end to end delegated credentialing process, including management of the Provider Directory and any related Provider Engagement Portal, or equivalent* Direct audit preparation of materials and files necessary to comply with external audits by payors and/or governmental agencies* Manages relationships with health plan delegation oversight committee members.* Leads process for initial and re-credentialing review by the Credentialing Committee and the Clinical Advisory Group for exception physicians* Conduct on-going program evaluations and audits of data integrity* Identifies opportunities and root-cause to improve the provider data management, credentialing and roster/directories production process and use of technology; identifies and resolves technical, operational and organization problems outside own team* Oversee provider health plan enrollment for employed physicians* Conduct audits of the credentialing database, confirming accurate input of provider data, and verifying accuracy of modifications made to the database and downstream impacts to other reporting tools and functions* Responsible for provider data integration of newly acquired entities or new customers including software and staff, ensures smooth transition of providers when on-boarding, for new contracts and during acquisitions, in collaboration with Network Operations* Develop monthly management reports illustrating status, back-log, and trends to be used at Monthly Operating Review* Manages staff including interviewing and selecting qualified candidates, coaching for career development, training, monitor productivity and accuracy, conducting performance evaluations, addressing guidelines and changes, consistent application of HR policies and procedures, and guide staff to confident decision-making.* Serves as SME and provides strategic direction for business requirements for producer data management and credentialing technologies* Support, participate and contribute to the development and growth of credentialing, customer service and provider services functions* Assumes responsibility for own personal continuing education and developmental needs; attends meetings, workshops to enrich personal knowledge, growth, and management skills.* Demonstrates the ability to be flexible, organized and function under stressful situations. Fosters good public relations for the company and the client.* Independently resolves issues and develops solutions for existing problems to be escalated to internal leadership where appropriate.* Bachelor’s degree or equivalent to 4-year university degree, preferably in healthcare related field of study.* Minimum of 10 years of credentialing, or regulatory affairs experience, preferably in a managed care or insurance environment. Ability to work with physicians in a collaborative manner.* 6 years of leadership experience.* Experience working with Management Services Organization (MSO), Health Plan or large at-risk provider practice; and IPA or medical groups.* Credentialing software experience.* Experience leading Health Plan audit activities.* Experience presenting to leadership – outlining plans for future success.* Ability to develop management reports.* Experience with and knowledge of CAQH and credentialing processes.* Knowledge of delegated credentialing and verification.* Knowledge of related accreditation and certification requirements.* Knowledge of medical credentialing procedures and standards.* Understands the use of credentialing software and automation to improve workflow* Understands how to support growth and scale as the organization grows customers* Ability to work with internal stakeholders to develop technical solutions to improve accuracy and efficiency of processes and reporting* Excellent communication skills, both written and verbal, as well as strong organizational and administrative abilities
+ Advanced Excel knowledge
+ Ability to create, implement, document and audit policies and procedures.
+ Ability to effectively prioritize and execute tasks in a high-pressure environment.
+ Ability to lead and manage others in a remote environment ensuring internal controls are followed.
+ Strong interpersonal, project management, and mentoring skills.* Excellent medical, vision, and dental coverage* 401k savings plan with a company match* Flexible time off and 9 Paid Holidays* This position will also be eligible to participate in our annual bonus program #J-18808-Ljbffr
+ Advanced Excel knowledge
+ Ability to create, implement, document and audit policies and procedures.
+ Ability to effectively prioritize and execute tasks in a high-pressure environment.
+ Ability to lead and manage others in a remote environment ensuring internal controls are followed.
+ Strong interpersonal, project management, and mentoring skills.* Excellent medical, vision, and dental coverage* 401k savings plan with a company match* Flexible time off and 9 Paid Holidays* This position will also be eligible to participate in our annual bonus program #J-18808-Ljbffr