Manager, ASC Credentialing (32615)

The GI Alliance Management LLC Company • $80K — $95K *
Southlake, TX 76092Hybrid
Healthcare
5 - 7 years of experience
Today
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Job Overview by Ladders

Qualifications

  • Minimum of five years' ASC credentialing experience
  • Proficiency with Microsoft Office (Word & Excel)
  • Experience in credentialing for major payers like Medicare, Medicaid, Tricare, BCBS, Aetna, Cigna, and Humana
  • Detailed knowledge of state and payer-specific guidelines
  • Strong organizational skills and attention to detail

Responsibilities

  • Ensure timely completion and follow-up on credentialing applications with payers
  • Collect primary source verification documentation for credentialing
  • Maintain positive relationships with payer representatives and internal departments
  • Update and maintain the credentialing database
  • Notify staff of provider credentialing updates for scheduling and billing
  • Prepare CAQH, NPI, and PECOS applications for providers
  • Submit monthly provider rosters to health plans and communicate changes

Benefits

  • Adhere to HIPAA privacy regulations
  • Opportunity to work independently and solve complex problems
  • Positive and collaborative work environment
  • Involvement in regulatory compliance and continuous learning
  • Engagement with a range of health plans and provider networks
Full Job Description
POSITION PURPOSE

The Manager, ASC Credentialing and Payer Operations, is responsible for the oversight of the ASC facility credentialing and recredentialing application process with all health plans. This position is also responsible for ensuring compliance with credentialing guidelines and understanding the credentialing processes for each of the health plans with which GI Alliance is contracted.

ESSENTIAL DUTIES AND RESPONSIBILITIES

  • Ensure accurate and timely completion, submission, and follow-up on all outstanding credentialing/recredentialing applications with payers and ASC locations.
  • Collect primary source verification documentation for initial credentialing, including licensing, board certifications, proof of professional liability insurance, and other necessary documents.
  • Establish and maintain positive working relationships with payer representatives, ASC medical staff, internal departments, and providers.
  • Maintain credentialing database and ensure information is up to date at all times.
  • Notify staff upon completion of provider credentialing and plan participation status for scheduling and billing purposes.
  • Prepare and maintain Standardized Credentialing Application, CAQH, and Availity for all providers.
  • Complete NPPES (NPI), PECOS (CMS), and Texas Medicaid applications.
  • Verify that all ASC credentialing requirements are met.
  • Responsible for monthly submission of provider roster to health plans and timely communication of group additions, changes, and terminations.
  • Stay abreast of regulatory requirements.
  • Adhere to HIPAA privacy regulations.
  • Perform other duties as assigned.


KEY COMPETENCIES

  • Experience in ASC and individual provider credentialing
  • Experience in credentialing of major payers such as Medicare, Medicaid, Tricare, BCBS, Aetna, Cigna, Humana, and other commercial and managed plans
  • Knowledge of state and payer specific guidelines
  • Experience in creating CAQH, NPI, and PECOS profiles and applications
  • Detail oriented and capable of exploring innovative solutions to solve complex problems
  • Ability to work independently and maintain a positive attitude
  • Ability to manage multiple and simultaneous responsibilities
  • Ability to maintain confidentiality of all medical, financial, and legal information
  • Ability to complete work assignments accurately and in a timely manner
  • Ability to communicate effectively, with excellent verbal and written communication and customer relation skills
  • Strong organizational skills


QUALIFICATIONS

  • Minimum of five (5) years' ASC credentialing experience
  • Proficiency with computer systems and Microsoft Office (Word & Excel) required

About The GI Alliance Management LLC Company

GI Alliance Management LLC Careers

There has never been a better time to join the team at GI Alliance Management LLC, a leader in gastrointestinal services. This company stands as a beacon of innovation and leadership in the healthcare sector.

Work You’ll Do

Join GI Alliance Management LLC's top-tier team to assist in transforming the landscape of gastrointestinal health services. This company leads with a commitment to excellence and a strategy focused on digital and medical innovation. Transform healthcare services with the brightest minds at GI Alliance Management LLC. This company holds a unique position in the marketplace, at the crossroads of healthcare expertise, technology, and transformative leadership. Engage with a professional team dedicated to advancing healthcare through cutting-edge technology and patient-centered care. Collaborate with the largest network of gastrointestinal health experts – a team dedicated to pioneering advancements in the field.

Introducing the GI Alliance Management LLC Professional Development Program

The team is building a market-leading program to ensure that all members master their skills in healthcare management and patient care, utilizing the latest in medical technology and practice management.

Do Innovative Work

Be part of a team that delivers targeted healthcare solutions through a depth and breadth of medical expertise and innovation that’s second to none.

Do Innovative Work

Engage in work that pushes the boundaries of traditional healthcare, providing solutions that enhance patient outcomes and streamline operations.

Be Part of a Great Team

Work within a diverse team that values leadership and teamwork, harnessing a wide range of medical technology and knowledge to improve patient care.

Future-proof Your Career

Advance your career with GI Alliance Management LLC, where the opportunities for growth and professional development are abundant. Benefit from unmatched training, development, and certification support.

Explore

Discover how GI Alliance Management LLC is leading the way in predictive healthcare management and patient care excellence.

The GI Alliance Management LLC Commitment to Diversity and Innovation

The combined expertise and dedication to innovation help clients and patients overcome challenges and lead healthier lives. Clients and patients rely on GI Alliance Management LLC for new strategies and solutions that drive growth and improvement in healthcare.

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Join the Team

Search open positions that match your skills and interests. GI Alliance Management LLC looks for passionate, curious, creative, and solution-driven team players. SEARCH GI ALLIANCE MANAGEMENT LLC JOBS

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* Ladders Estimates

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