Location

This position is full-time (40 hours/week) Monday-Friday from 8:00am-5:00pm and will be remote. Our ideal candidate must reside within reasonable proximity to Columbia, SC as they may be required to report onsite occasionally for trainings, meetings, or other business needs.

What You’ll Do:

• Manages day-to-day operations of credentialing area to include delegated credentialing activities. Develops/implements credentialing policies/procedures/evaluation tools. Evaluates/monitors/ensures compliance with National Committee of Quality Assurance (NCQA) and other regulatory standards/external review bodies.  Conducts on-site audits and inspections of delegated entities/provider files.

• Communicates with/responds to internal and external representatives regarding data, delegation agreements, facility credentialing, and sanction issues.  Works with other departments to address/resolve credentialing issues.

• Promotes efficiency through planning, problem solving, and application of industry standards.  Maintains accurate/current/efficient databases.

• Coordinates/manages all activities and follows-up for credentialing committee.  Presents physicians/practitioners/providers with quality issues to committee for review.

• Selects/trains/develops/guides staff and ensures excellent customer service is given to employees/customers/management, etc.  Monitors department performance and productivity.  Performs quality control functions for work performed.  Makes recommendations on process improvements and identifies training needs for staff.

To Qualify for This Position, You'll Need the Following:

• Required Education: Bachelor's in a job-related field

• Required Work Experience: 5 years healthcare experience to include healthcare program management, provider network, contracting or credentialing, managed care, medical education training, or physician office management; 2 of the 5 years must have been in supervisory role or equivalent military experience in grade E4 or above.

• Required Skills and Abilities: Knowledge/understanding of NCQA and JCAHO credentialing standards, credentialing/recredentialing process for healthcare practitioners and ancillary/institutional providers.

• Knowledge of medical terminology.

• Ability to work independently, prioritize effectively, make sound decisions.

• Good judgment skills.

• Demonstrated customer service, organizational, and presentation skills.

• Demonstrated verbal and written communication skills.

• Analytical or critical thinking skills.

• Ability to direct, motivate, and assess performance of others.

We Prefer That You Have the Following:

• Preferred Skills and Abilities: Must have a strong background in developing credentialing processes, system deployments, and workforce management.

Our Comprehensive Benefits Package Includes the Following:

We offer our employees great benefits and rewards.  You will be eligible to participate in the benefits for the first of the month following 28 days of employment.  

• Subsidized health plans, dental and vision coverage

• 401k retirement savings plan with company match

• Life Insurance

• Paid Time Off (PTO)

• On-site cafeterias and fitness centers in major locations

• Education Assistance

• Service Recognition

• National discounts to movies, theaters, zoos, theme parks and more

What We Can Do for You:

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

What To Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Management will conduct interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.