- Professional
- Escritório em Washington
** This position is hybrid and will require to be in the office 4 days a week **
The HSCSN Credentialing Program Manager manages the Health Plan's provider credentialing activities, provider data management, and data reporting functions. The Credentialing Program Lead develops, performs and tracks t the credentialing and recredentialing process and ensures activities meet Health Plan regulatory and contractual guidelines. This includes the management and performance oversight of Provider Credentialing delegates to ensure compliance with Health Plan and Medicaid market contract requirements. Additionally, the Program Lead is responsible for managing the Health Plan's online and published provider directory process.
Minimum Education
Bachelor's Degree (Preferred)
Minimum Work Experience
10 years progressive experience in managed care provider credentialing, with at minimum, exposure to healthcare credentialing (Required)
Required Skills/Knowledge
Proficiency in MS word and Windows.
Experience in working within credentialing systems and databases such as CACTUS or other
Proficient in MS Excel and ability to manage provider demographics and other provide data sets
Understanding of Medicaid contracts, market and other regulatory requirement related to provider networks, geographical access and credentialing requirements.
Job Functions
Organizational Accountabilities
Organizational Accountabilities (Managers)
Leadership Excellence
Collaboration
Leadership Skills
Supervisory Responsibilities
Blood Borne Pathogen Exposure
Protected Health Information Access Level
Working Environment
Physical Requirements
Travel Requirements
- DC residents are encouraged to apply!
