This position oversees the development, management, and monitoring of all credentialing and re-credentialing processes, ensuring efficiency and accuracy. The Credentialing Manager contributes and supports Credentialing Verification Organization (CVO) strategic planning, helps prepare the credentialing budget, and ensures compliance with appropriate accrediting and regulatory agencies. This position trains and supervises credentialing staff, supports the Credentialing Committee, and completes credentialing audits as required.

Duties include following established UPHP policies and procedures, performing supervisory functions, obtaining and maintaining NCQA certification for the CVO, developing and marketing CVO services, ensuring compliance with licensing standards and accrediting organizations (NCQA, The Joint Commission, MDHHS, DIFS, CMS), monitoring performance indicators, processing provider membership and reappointment applications, maintaining credentialing database and audits, compiling credentialing reports, collaborating with internal departments, maintaining provider lists and screening including reviews from MSA, OIG, and LARA, undertaking projects and attending meetings, and maintaining confidentiality of client data.

Educational requirements: Associate degree in business, health information processing, health information systems, or related field required. Preferred: Bachelor's degree in office, business administration or healthcare-related area; NAMSS Certification as Certified Provider Credentialing Specialist (CPCS).

Experience: Minimum 3-4 years of progressive office experience. Preferred 3-4 years of credentialing and/or management experience with supervisory experience.

Skills: Proficiency with MS Office, keyboarding proficiency, excellent communication and organizational skills, ability to work independently and prioritize tasks.

Physical requirements include ability to access files and computer information, moderate physical effort, occasional lifting up to 25 pounds, reaching, stooping, bending, kneeling, prolonged sitting or standing, manual dexterity, and mobility.

Working conditions: Office environment with occasional travel, frequent interruptions, occasional irregular hours and evening meetings.